|
HC LITHIUM ION BATTERY, CHARGER
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT L7368
|
| Hospital Charge Code |
915357368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: United Healthcare HMO Rider |
$303.79
|
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Blue Shield of California Commercial |
$681.70
|
| Rate for Payer: Blue Shield of California EPN |
$428.40
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Cigna of CA HMO |
$595.00
|
| Rate for Payer: Cigna of CA PPO |
$595.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$310.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.38
|
|
|
HC LITHIUM ION BATTERY, REPLACMNT
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT L7367
|
| Hospital Charge Code |
905357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$551.70 |
| Rate for Payer: Adventist Health Commercial |
$122.60
|
| Rate for Payer: Blue Shield of California Commercial |
$491.63
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Senior |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.60
|
| Rate for Payer: Multiplan Commercial |
$459.75
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.06
|
| Rate for Payer: United Healthcare All Other HMO |
$223.93
|
| Rate for Payer: United Healthcare HMO Rider |
$219.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.76
|
|
|
HC LITHIUM ION BATTERY, REPLACMNT
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
CPT L7367
|
| Hospital Charge Code |
915357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$551.70 |
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: Adventist Health Commercial |
$122.60
|
| Rate for Payer: Blue Shield of California Commercial |
$491.63
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Senior |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.60
|
| Rate for Payer: Multiplan Commercial |
$459.75
|
| Rate for Payer: Networks By Design Commercial |
$398.45
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.06
|
| Rate for Payer: United Healthcare All Other HMO |
$223.93
|
| Rate for Payer: United Healthcare HMO Rider |
$219.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.76
|
|
|
HC LITHIUM ION BATTERY, REPLACMNT
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT L7367
|
| Hospital Charge Code |
915357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.76 |
| Max. Negotiated Rate |
$551.70 |
| Rate for Payer: Adventist Health Commercial |
$251.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.58
|
| Rate for Payer: Blue Shield of California Commercial |
$491.63
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Senior |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$421.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$429.10
|
| Rate for Payer: Multiplan Commercial |
$459.75
|
| Rate for Payer: Networks By Design Commercial |
$306.50
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: Riverside University Health System MISP |
$245.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.06
|
| Rate for Payer: United Healthcare All Other HMO |
$223.93
|
| Rate for Payer: United Healthcare HMO Rider |
$219.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.05
|
| Rate for Payer: Vantage Medical Group Senior |
$521.05
|
|
|
HC LITHIUM ION BATTERY, REPLACMNT
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT L7367
|
| Hospital Charge Code |
905357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.76 |
| Max. Negotiated Rate |
$551.70 |
| Rate for Payer: Adventist Health Commercial |
$251.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.58
|
| Rate for Payer: Blue Shield of California Commercial |
$491.63
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Senior |
$245.20
|
| Rate for Payer: Galaxy Health WC |
$521.05
|
| Rate for Payer: Global Benefits Group Commercial |
$367.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$551.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$421.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$465.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$429.10
|
| Rate for Payer: Multiplan Commercial |
$459.75
|
| Rate for Payer: Networks By Design Commercial |
$306.50
|
| Rate for Payer: Prime Health Services Commercial |
$521.05
|
| Rate for Payer: Riverside University Health System MISP |
$245.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.06
|
| Rate for Payer: United Healthcare All Other HMO |
$223.93
|
| Rate for Payer: United Healthcare HMO Rider |
$219.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.05
|
| Rate for Payer: Vantage Medical Group Senior |
$521.05
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$39,698.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,939.60 |
| Max. Negotiated Rate |
$35,728.20 |
| Rate for Payer: Adventist Health Commercial |
$7,939.60
|
| Rate for Payer: Cash Price |
$17,864.10
|
| Rate for Payer: Central Health Plan Commercial |
$31,758.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,788.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,879.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,879.20
|
| Rate for Payer: Galaxy Health WC |
$33,743.30
|
| Rate for Payer: Global Benefits Group Commercial |
$23,818.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,728.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,208.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,421.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,939.60
|
| Rate for Payer: Multiplan Commercial |
$29,773.50
|
| Rate for Payer: Networks By Design Commercial |
$25,803.70
|
| Rate for Payer: Prime Health Services Commercial |
$33,743.30
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$39,698.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,939.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$17,864.10
|
| Rate for Payer: Cash Price |
$17,864.10
|
| Rate for Payer: Cash Price |
$17,864.10
|
| Rate for Payer: Central Health Plan Commercial |
$31,758.40
|
| Rate for Payer: Cigna of CA HMO |
$25,406.72
|
| Rate for Payer: Cigna of CA PPO |
$29,376.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,788.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$33,743.30
|
| Rate for Payer: Global Benefits Group Commercial |
$23,818.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,728.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,208.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,939.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$29,773.50
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$25,803.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$33,743.30
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,818.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,849.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC LIVER ACQUISITION
|
Facility
|
OP
|
$79,296.00
|
|
|
Service Code
|
CPT 47135
|
| Hospital Charge Code |
905800150
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$11,461.00 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,757.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,612.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,472.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$50,273.66
|
| Rate for Payer: Blue Shield of California EPN |
$31,639.10
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Cigna of CA HMO |
$50,749.44
|
| Rate for Payer: Cigna of CA PPO |
$58,679.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67,401.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55,507.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,480.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50,352.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,519.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,784.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55,507.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
| Rate for Payer: Riverside University Health System MISP |
$31,718.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,577.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47,577.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Senior |
$67,401.60
|
|
|
HC LIVER ACQUISITION
|
Facility
|
IP
|
$79,296.00
|
|
|
Service Code
|
CPT 47135
|
| Hospital Charge Code |
905800150
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55,507.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50,352.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,784.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$6,623.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,324.60 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,636.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,649.20
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,205.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,907.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$6,623.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,324.60 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,636.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,649.20
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,205.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,907.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$6,623.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$289.44 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$557.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,172.49
|
| Rate for Payer: Blue Shield of California EPN |
$2,629.33
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Cigna of CA HMO |
$4,238.72
|
| Rate for Payer: Cigna of CA PPO |
$4,901.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,636.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,205.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,311.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,311.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,311.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,311.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$6,623.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$289.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Cigna of CA HMO |
$4,238.72
|
| Rate for Payer: Cigna of CA PPO |
$4,901.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,636.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,205.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,549.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,311.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.88 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$855.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Riverside University Health System MISP |
$402.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.10
|
| Rate for Payer: Vantage Medical Group Senior |
$855.10
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$905.40 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC LIVER ELASTOGRAPHY
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 91200
|
| Hospital Charge Code |
906743912
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$55.13 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$217.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.41
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.50
|
| Rate for Payer: United Healthcare All Other HMO |
$207.50
|
| Rate for Payer: United Healthcare HMO Rider |
$207.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC LIVER ELASTOGRAPHY
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 91200
|
| Hospital Charge Code |
906743912
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC LIVER SPECT
|
Facility
|
OP
|
$2,144.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$428.80 |
| Max. Negotiated Rate |
$1,929.60 |
| Rate for Payer: Adventist Health Commercial |
$428.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,302.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,822.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,179.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,608.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,214.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,247.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,350.72
|
| Rate for Payer: Blue Shield of California EPN |
$851.17
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,715.20
|
| Rate for Payer: Cigna of CA HMO |
$1,372.16
|
| Rate for Payer: Cigna of CA PPO |
$1,586.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,822.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,822.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,822.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,500.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.60
|
| Rate for Payer: EPIC Health Plan Senior |
$857.60
|
| Rate for Payer: Galaxy Health WC |
$1,822.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,286.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,929.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,361.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$778.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,264.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,500.80
|
| Rate for Payer: Multiplan Commercial |
$1,608.00
|
| Rate for Payer: Networks By Design Commercial |
$1,393.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,822.40
|
| Rate for Payer: Riverside University Health System MISP |
$857.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,286.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,286.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,072.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,072.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,072.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,822.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,822.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,822.40
|
|
|
HC LIVER SPECT
|
Facility
|
IP
|
$2,144.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
909301350
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$428.80 |
| Max. Negotiated Rate |
$1,929.60 |
| Rate for Payer: Adventist Health Commercial |
$428.80
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,715.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,500.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$857.60
|
| Rate for Payer: EPIC Health Plan Senior |
$857.60
|
| Rate for Payer: Galaxy Health WC |
$1,822.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,286.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,929.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,361.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,264.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.80
|
| Rate for Payer: Multiplan Commercial |
$1,608.00
|
| Rate for Payer: Networks By Design Commercial |
$1,393.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,822.40
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$1,627.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$1,464.30 |
| Rate for Payer: Adventist Health Commercial |
$325.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,065.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$604.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$946.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,025.01
|
| Rate for Payer: Blue Shield of California EPN |
$645.92
|
| Rate for Payer: Cash Price |
$732.15
|
| Rate for Payer: Cash Price |
$732.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,301.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.28
|
| Rate for Payer: Cigna of CA PPO |
$1,203.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,382.95
|
| Rate for Payer: Global Benefits Group Commercial |
$976.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,464.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,033.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,220.25
|
| Rate for Payer: Networks By Design Commercial |
$1,057.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.95
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$976.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$976.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$1,627.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$325.40 |
| Max. Negotiated Rate |
$1,464.30 |
| Rate for Payer: Adventist Health Commercial |
$325.40
|
| Rate for Payer: Cash Price |
$732.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,301.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.80
|
| Rate for Payer: EPIC Health Plan Senior |
$650.80
|
| Rate for Payer: Galaxy Health WC |
$1,382.95
|
| Rate for Payer: Global Benefits Group Commercial |
$976.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,464.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,033.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.40
|
| Rate for Payer: Multiplan Commercial |
$1,220.25
|
| Rate for Payer: Networks By Design Commercial |
$1,057.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.95
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,720.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,505.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$860.00
|
| Rate for Payer: EPIC Health Plan Senior |
$860.00
|
| Rate for Payer: Galaxy Health WC |
$1,827.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,290.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,935.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,365.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,268.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.00
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: Networks By Design Commercial |
$1,397.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,827.50
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$195.74 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$652.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$718.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,250.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,354.50
|
| Rate for Payer: Blue Shield of California EPN |
$853.55
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,720.00
|
| Rate for Payer: Cigna of CA HMO |
$1,376.00
|
| Rate for Payer: Cigna of CA PPO |
$1,591.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,505.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,827.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,290.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,935.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,365.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$216.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: Networks By Design Commercial |
$1,397.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,827.50
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,290.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,290.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
IP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$2,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,423.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,350.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$7,637.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
|
|
HC LIVNG FUNCT RESTRTN UE
|
Facility
|
OP
|
$11,750.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,848.12 |
| Max. Negotiated Rate |
$10,575.00 |
| Rate for Payer: Adventist Health Commercial |
$4,817.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,462.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,812.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,834.98
|
| Rate for Payer: Blue Shield of California Commercial |
$9,423.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,922.00
|
| Rate for Payer: Cash Price |
$5,287.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,400.00
|
| Rate for Payer: Cigna of CA HMO |
$8,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,225.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,987.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,987.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,700.00
|
| Rate for Payer: Galaxy Health WC |
$9,987.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,575.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,461.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,265.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,932.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,817.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,225.00
|
| Rate for Payer: Multiplan Commercial |
$8,812.50
|
| Rate for Payer: Networks By Design Commercial |
$5,875.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,987.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,409.77
|
| Rate for Payer: United Healthcare All Other HMO |
$4,292.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,199.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,848.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,987.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,987.50
|
|
