|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$1,404.90 |
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,248.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.40
|
| Rate for Payer: Galaxy Health WC |
$1,326.85
|
| Rate for Payer: Global Benefits Group Commercial |
$936.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,404.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.20
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
| Rate for Payer: Networks By Design Commercial |
$1,014.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,326.85
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.79 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$936.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,248.80
|
| Rate for Payer: Cigna of CA PPO |
$1,155.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,326.85
|
| Rate for Payer: Global Benefits Group Commercial |
$936.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,404.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,170.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,170.75
|
| Rate for Payer: Networks By Design Commercial |
$1,014.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,326.85
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$936.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.25
|
| Rate for Payer: Blue Distinction Transplant |
$140.40
|
| Rate for Payer: Blue Shield of California Commercial |
$147.19
|
| Rate for Payer: Blue Shield of California EPN |
$114.43
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Central Health Plan Commercial |
$187.20
|
| Rate for Payer: Cigna of CA HMO |
$149.76
|
| Rate for Payer: Cigna of CA PPO |
$173.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$198.90
|
| Rate for Payer: Global Benefits Group Commercial |
$140.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$152.10
|
| Rate for Payer: Prime Health Services Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.00
|
| Rate for Payer: United Healthcare All Other HMO |
$117.00
|
| Rate for Payer: United Healthcare HMO Rider |
$117.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Central Health Plan Commercial |
$187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.60
|
| Rate for Payer: Galaxy Health WC |
$198.90
|
| Rate for Payer: Global Benefits Group Commercial |
$140.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$152.10
|
| Rate for Payer: Prime Health Services Commercial |
$198.90
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$111.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.25
|
| Rate for Payer: Blue Distinction Transplant |
$140.40
|
| Rate for Payer: Blue Shield of California Commercial |
$147.19
|
| Rate for Payer: Blue Shield of California EPN |
$114.43
|
| Rate for Payer: Caremore Medicare Advantage |
$111.37
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Central Health Plan Commercial |
$187.20
|
| Rate for Payer: Cigna of CA HMO |
$149.76
|
| Rate for Payer: Cigna of CA PPO |
$173.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$198.90
|
| Rate for Payer: Global Benefits Group Commercial |
$140.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: InnovAge PACE Commercial |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$152.10
|
| Rate for Payer: Prime Health Services Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Medicare |
$118.05
|
| Rate for Payer: Riverside University Health System MISP |
$122.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.00
|
| Rate for Payer: United Healthcare All Other HMO |
$117.00
|
| Rate for Payer: United Healthcare HMO Rider |
$117.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Central Health Plan Commercial |
$187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.60
|
| Rate for Payer: Galaxy Health WC |
$198.90
|
| Rate for Payer: Global Benefits Group Commercial |
$140.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$152.10
|
| Rate for Payer: Prime Health Services Commercial |
$198.90
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.00
|
| Rate for Payer: Galaxy Health WC |
$1,249.50
|
| Rate for Payer: Global Benefits Group Commercial |
$882.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,323.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$980.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$1,102.50
|
| Rate for Payer: Networks By Design Commercial |
$955.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,249.50
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,249.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$808.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$882.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,176.00
|
| Rate for Payer: Cigna of CA PPO |
$1,087.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,249.50
|
| Rate for Payer: Dignity Health Media |
$1,249.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,249.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$588.00
|
| Rate for Payer: Galaxy Health WC |
$1,249.50
|
| Rate for Payer: Global Benefits Group Commercial |
$882.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,323.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,102.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$514.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$980.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.00
|
| Rate for Payer: Multiplan Commercial |
$1,102.50
|
| Rate for Payer: Networks By Design Commercial |
$955.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,249.50
|
| Rate for Payer: Riverside University Health System MISP |
$588.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$882.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,249.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,249.50
|
|
|
HC C GLABRATA AND C KRUSEI NAT
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: Blue Distinction Transplant |
$46.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.91
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC C GLABRATA AND C KRUSEI NAT
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900912494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
OP
|
$6,495.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$858.04 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,897.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,196.00
|
| Rate for Payer: Cigna of CA PPO |
$4,806.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$5,520.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,897.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,845.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,871.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,332.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,299.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$4,871.25
|
| Rate for Payer: Networks By Design Commercial |
$4,221.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,520.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,897.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
IP
|
$6,495.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,299.00 |
| Max. Negotiated Rate |
$5,845.50 |
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,598.00
|
| Rate for Payer: Galaxy Health WC |
$5,520.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,897.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,845.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,332.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,474.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,299.00
|
| Rate for Payer: Multiplan Commercial |
$4,871.25
|
| Rate for Payer: Networks By Design Commercial |
$4,221.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,520.75
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
OP
|
$4,590.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,754.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,672.00
|
| Rate for Payer: Cigna of CA PPO |
$3,396.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,901.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,131.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,442.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,061.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,442.50
|
| Rate for Payer: Networks By Design Commercial |
$2,983.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,901.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,754.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
IP
|
$4,590.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$4,131.00 |
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,836.00
|
| Rate for Payer: Galaxy Health WC |
$3,901.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,131.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,061.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.00
|
| Rate for Payer: Multiplan Commercial |
$3,442.50
|
| Rate for Payer: Networks By Design Commercial |
$2,983.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,901.50
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
IP
|
$4,955.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$991.00 |
| Max. Negotiated Rate |
$4,459.50 |
| Rate for Payer: Cash Price |
$2,229.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,964.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,982.00
|
| Rate for Payer: Galaxy Health WC |
$4,211.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,973.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,459.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,304.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,887.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.00
|
| Rate for Payer: Multiplan Commercial |
$3,716.25
|
| Rate for Payer: Networks By Design Commercial |
$3,220.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,211.75
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
OP
|
$4,955.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$4,459.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,973.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$2,229.75
|
| Rate for Payer: Cash Price |
$2,229.75
|
| Rate for Payer: Cash Price |
$2,229.75
|
| Rate for Payer: Cash Price |
$2,229.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,964.00
|
| Rate for Payer: Cigna of CA PPO |
$3,666.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$4,211.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,973.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,459.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,716.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,304.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$3,716.25
|
| Rate for Payer: Networks By Design Commercial |
$3,220.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,211.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,973.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,477.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,477.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,477.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,477.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
OP
|
$9,772.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,954.40 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,863.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,817.60
|
| Rate for Payer: Cigna of CA PPO |
$7,231.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$8,306.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,863.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,794.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,329.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,517.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,589.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,954.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$7,329.00
|
| Rate for Payer: Networks By Design Commercial |
$6,351.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,306.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,863.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
IP
|
$9,772.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,954.40 |
| Max. Negotiated Rate |
$8,794.80 |
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,817.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,908.80
|
| Rate for Payer: Galaxy Health WC |
$8,306.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,863.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,794.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,517.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,723.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,954.40
|
| Rate for Payer: Multiplan Commercial |
$7,329.00
|
| Rate for Payer: Networks By Design Commercial |
$6,351.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,306.20
|
|
|
HC CHARTIS CATHETER
|
Facility
|
OP
|
$3,783.00
|
|
| Hospital Charge Code |
900800954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,297.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,080.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,080.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,831.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,235.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,269.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,849.89
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| Rate for Payer: Cigna of CA HMO |
$2,421.12
|
| Rate for Payer: Cigna of CA PPO |
$2,799.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Dignity Health Media |
$3,215.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,215.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,513.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,513.20
|
| Rate for Payer: Galaxy Health WC |
$3,215.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,404.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,837.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,324.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,523.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,441.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.60
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,513.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,269.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,269.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,891.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,891.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,891.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,215.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,215.55
|
|
|
HC CHARTIS CATHETER
|
Facility
|
IP
|
$3,783.00
|
|
| Hospital Charge Code |
900800954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,513.20
|
| Rate for Payer: Galaxy Health WC |
$3,215.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,404.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,523.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,441.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.60
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Media |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$200.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Media |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$200.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN OT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905104155
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
