|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,560.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,726.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.20
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$6,357.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,560.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,726.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.20
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$6,357.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,457.17 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Adventist Health Commercial |
$4,010.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,744.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,560.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,313.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,457.17
|
| Rate for Payer: InnovAge PACE Commercial |
$4,890.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,010.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,846.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,846.70
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,912.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
OP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,034.66 |
| Max. Negotiated Rate |
$13,835.70 |
| Rate for Payer: Adventist Health Commercial |
$6,302.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,455.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,529.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,028.56
|
| Rate for Payer: Blue Shield of California Commercial |
$11,883.33
|
| Rate for Payer: Blue Shield of California EPN |
$7,747.99
|
| Rate for Payer: Cash Price |
$6,917.85
|
| Rate for Payer: Central Health Plan Commercial |
$12,298.40
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,067.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,067.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,835.70
|
| Rate for Payer: InnovAge PACE Commercial |
$7,686.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,253.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,857.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,515.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,302.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,761.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,761.10
|
| Rate for Payer: Multiplan Commercial |
$11,529.75
|
| Rate for Payer: Networks By Design Commercial |
$7,686.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: Riverside University Health System MISP |
$6,149.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,223.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13,067.05
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
IP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,074.60 |
| Max. Negotiated Rate |
$13,835.70 |
| Rate for Payer: Adventist Health Commercial |
$3,074.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11,883.33
|
| Rate for Payer: Blue Shield of California EPN |
$7,747.99
|
| Rate for Payer: Cash Price |
$6,917.85
|
| Rate for Payer: Central Health Plan Commercial |
$12,298.40
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,835.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,253.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,857.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,515.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,074.60
|
| Rate for Payer: Multiplan Commercial |
$11,529.75
|
| Rate for Payer: Networks By Design Commercial |
$9,992.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
|
|
HC KD PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$6,320.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,069.80 |
| Max. Negotiated Rate |
$5,688.00 |
| Rate for Payer: Adventist Health Commercial |
$2,591.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,476.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,740.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,711.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4,885.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,185.28
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,056.00
|
| Rate for Payer: Cigna of CA HMO |
$4,424.00
|
| Rate for Payer: Cigna of CA PPO |
$4,424.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,372.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,528.00
|
| Rate for Payer: Galaxy Health WC |
$5,372.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,688.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,912.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,424.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,424.00
|
| Rate for Payer: Multiplan Commercial |
$4,740.00
|
| Rate for Payer: Networks By Design Commercial |
$3,160.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,372.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,528.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,372.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,372.00
|
|
|
HC KD PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$6,320.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,264.00 |
| Max. Negotiated Rate |
$5,688.00 |
| Rate for Payer: Adventist Health Commercial |
$1,264.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,885.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,185.28
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,056.00
|
| Rate for Payer: Cigna of CA HMO |
$4,424.00
|
| Rate for Payer: Cigna of CA PPO |
$4,424.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,528.00
|
| Rate for Payer: Galaxy Health WC |
$5,372.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,688.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,912.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,264.00
|
| Rate for Payer: Multiplan Commercial |
$4,740.00
|
| Rate for Payer: Networks By Design Commercial |
$4,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.80
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$404.13 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.73
|
| Rate for Payer: Blue Shield of California Commercial |
$953.88
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$759.53
|
| Rate for Payer: InnovAge PACE Commercial |
$617.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Riverside University Health System MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Blue Shield of California Commercial |
$953.88
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Blue Shield of California Commercial |
$953.88
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$404.13 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.73
|
| Rate for Payer: Blue Shield of California Commercial |
$953.88
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$759.53
|
| Rate for Payer: InnovAge PACE Commercial |
$617.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Riverside University Health System MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$132.46 |
| Max. Negotiated Rate |
$1,261.80 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$851.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$823.39
|
| Rate for Payer: Blue Shield of California Commercial |
$851.01
|
| Rate for Payer: Blue Shield of California EPN |
$556.59
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,121.60
|
| Rate for Payer: Cigna of CA HMO |
$897.28
|
| Rate for Payer: Cigna of CA PPO |
$1,037.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,191.70
|
| Rate for Payer: Global Benefits Group Commercial |
$841.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,261.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$935.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
| Rate for Payer: Networks By Design Commercial |
$911.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,191.70
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$841.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$841.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$280.40 |
| Max. Negotiated Rate |
$1,261.80 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.80
|
| Rate for Payer: EPIC Health Plan Senior |
$560.80
|
| Rate for Payer: Galaxy Health WC |
$1,191.70
|
| Rate for Payer: Global Benefits Group Commercial |
$841.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,261.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$935.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.40
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
| Rate for Payer: Networks By Design Commercial |
$911.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,191.70
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$2,189.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$437.80 |
| Max. Negotiated Rate |
$1,970.10 |
| Rate for Payer: Adventist Health Commercial |
$437.80
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,751.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$875.60
|
| Rate for Payer: EPIC Health Plan Senior |
$875.60
|
| Rate for Payer: Galaxy Health WC |
$1,860.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,313.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,970.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,460.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$834.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,354.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.80
|
| Rate for Payer: Multiplan Commercial |
$1,641.75
|
| Rate for Payer: Networks By Design Commercial |
$1,422.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,860.65
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$2,189.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.11 |
| Max. Negotiated Rate |
$1,970.10 |
| Rate for Payer: Adventist Health Commercial |
$437.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,329.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$731.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,328.72
|
| Rate for Payer: Blue Shield of California EPN |
$869.03
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,751.20
|
| Rate for Payer: Cigna of CA HMO |
$1,400.96
|
| Rate for Payer: Cigna of CA PPO |
$1,619.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,860.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,313.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,970.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$206.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,460.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,641.75
|
| Rate for Payer: Networks By Design Commercial |
$1,422.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,860.65
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,313.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,313.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC KIT ABLATION CRYOSPRAY
|
Facility
|
OP
|
$3,737.50
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
900100315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.50 |
| Max. Negotiated Rate |
$3,363.75 |
| Rate for Payer: Adventist Health Commercial |
$747.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,269.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,176.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,055.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,803.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,809.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,195.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,283.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.26
|
| Rate for Payer: Cash Price |
$1,681.88
|
| Rate for Payer: Central Health Plan Commercial |
$2,990.00
|
| Rate for Payer: Cigna of CA HMO |
$2,392.00
|
| Rate for Payer: Cigna of CA PPO |
$2,765.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,176.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,176.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,176.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,495.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,495.00
|
| Rate for Payer: Galaxy Health WC |
$3,176.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,242.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,363.75
|
| Rate for Payer: InnovAge PACE Commercial |
$1,868.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,492.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,423.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,313.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,616.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,616.25
|
| Rate for Payer: Multiplan Commercial |
$2,803.12
|
| Rate for Payer: Networks By Design Commercial |
$2,429.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,176.88
|
| Rate for Payer: Riverside University Health System MISP |
$1,495.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,242.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,242.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,868.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,868.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,176.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,176.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,176.88
|
|
|
HC KIT ABLATION CRYOSPRAY
|
Facility
|
IP
|
$3,737.50
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
900100315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.50 |
| Max. Negotiated Rate |
$3,363.75 |
| Rate for Payer: Adventist Health Commercial |
$747.50
|
| Rate for Payer: Cash Price |
$1,681.88
|
| Rate for Payer: Central Health Plan Commercial |
$2,990.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,495.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,495.00
|
| Rate for Payer: Galaxy Health WC |
$3,176.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,242.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,363.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,492.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,423.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,313.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.50
|
| Rate for Payer: Multiplan Commercial |
$2,803.12
|
| Rate for Payer: Networks By Design Commercial |
$2,429.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,176.88
|
|
|
HC KIT, ADULT CENTRAL LINE DRES CHANGE
|
Facility
|
OP
|
$194.81
|
|
| Hospital Charge Code |
901607207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$175.33 |
| Rate for Payer: Adventist Health Commercial |
$38.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.41
|
| Rate for Payer: Blue Shield of California Commercial |
$119.03
|
| Rate for Payer: Blue Shield of California EPN |
$77.73
|
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: Central Health Plan Commercial |
$155.85
|
| Rate for Payer: Cigna of CA HMO |
$124.68
|
| Rate for Payer: Cigna of CA PPO |
$144.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.92
|
| Rate for Payer: EPIC Health Plan Senior |
$77.92
|
| Rate for Payer: Galaxy Health WC |
$165.59
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.33
|
| Rate for Payer: InnovAge PACE Commercial |
$97.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.37
|
| Rate for Payer: Multiplan Commercial |
$146.11
|
| Rate for Payer: Networks By Design Commercial |
$126.63
|
| Rate for Payer: Prime Health Services Commercial |
$165.59
|
| Rate for Payer: Riverside University Health System MISP |
$77.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.41
|
| Rate for Payer: United Healthcare All Other HMO |
$97.41
|
| Rate for Payer: United Healthcare HMO Rider |
$97.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.59
|
| Rate for Payer: Vantage Medical Group Senior |
$165.59
|
|
|
HC KIT, ADULT CENTRAL LINE DRES CHANGE
|
Facility
|
IP
|
$194.81
|
|
| Hospital Charge Code |
901607207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$175.33 |
| Rate for Payer: Adventist Health Commercial |
$38.96
|
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: Central Health Plan Commercial |
$155.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.92
|
| Rate for Payer: EPIC Health Plan Senior |
$77.92
|
| Rate for Payer: Galaxy Health WC |
$165.59
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.96
|
| Rate for Payer: Multiplan Commercial |
$146.11
|
| Rate for Payer: Networks By Design Commercial |
$126.63
|
| Rate for Payer: Prime Health Services Commercial |
$165.59
|
|
|
HC KIT, ARTERIAL LINE DRSNG CHNG
|
Facility
|
IP
|
$96.84
|
|
| Hospital Charge Code |
901607861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$87.16 |
| Rate for Payer: Adventist Health Commercial |
$19.37
|
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Central Health Plan Commercial |
$77.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.74
|
| Rate for Payer: EPIC Health Plan Senior |
$38.74
|
| Rate for Payer: Galaxy Health WC |
$82.31
|
| Rate for Payer: Global Benefits Group Commercial |
$58.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.37
|
| Rate for Payer: Multiplan Commercial |
$72.63
|
| Rate for Payer: Networks By Design Commercial |
$62.95
|
| Rate for Payer: Prime Health Services Commercial |
$82.31
|
|
|
HC KIT, ARTERIAL LINE DRSNG CHNG
|
Facility
|
OP
|
$96.84
|
|
| Hospital Charge Code |
901607861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$87.16 |
| Rate for Payer: Adventist Health Commercial |
$19.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.87
|
| Rate for Payer: Blue Shield of California Commercial |
$59.17
|
| Rate for Payer: Blue Shield of California EPN |
$38.64
|
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Central Health Plan Commercial |
$77.47
|
| Rate for Payer: Cigna of CA HMO |
$61.98
|
| Rate for Payer: Cigna of CA PPO |
$71.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.74
|
| Rate for Payer: EPIC Health Plan Senior |
$38.74
|
| Rate for Payer: Galaxy Health WC |
$82.31
|
| Rate for Payer: Global Benefits Group Commercial |
$58.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.16
|
| Rate for Payer: InnovAge PACE Commercial |
$48.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.79
|
| Rate for Payer: Multiplan Commercial |
$72.63
|
| Rate for Payer: Networks By Design Commercial |
$62.95
|
| Rate for Payer: Prime Health Services Commercial |
$82.31
|
| Rate for Payer: Riverside University Health System MISP |
$38.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.42
|
| Rate for Payer: United Healthcare All Other HMO |
$48.42
|
| Rate for Payer: United Healthcare HMO Rider |
$48.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.31
|
| Rate for Payer: Vantage Medical Group Senior |
$82.31
|
|
|
HC KIT CATH CNTRL VNS 2.5FR
|
Facility
|
OP
|
$281.33
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$253.20 |
| Rate for Payer: Adventist Health Commercial |
$56.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.77
|
| Rate for Payer: Blue Shield of California Commercial |
$217.47
|
| Rate for Payer: Blue Shield of California EPN |
$141.79
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Central Health Plan Commercial |
$225.06
|
| Rate for Payer: Cigna of CA HMO |
$196.93
|
| Rate for Payer: Cigna of CA PPO |
$196.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.53
|
| Rate for Payer: EPIC Health Plan Senior |
$112.53
|
| Rate for Payer: Galaxy Health WC |
$239.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.20
|
| Rate for Payer: InnovAge PACE Commercial |
$140.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.93
|
| Rate for Payer: Multiplan Commercial |
$211.00
|
| Rate for Payer: Networks By Design Commercial |
$140.66
|
| Rate for Payer: Prime Health Services Commercial |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$112.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.58
|
| Rate for Payer: United Healthcare All Other HMO |
$102.77
|
| Rate for Payer: United Healthcare HMO Rider |
$100.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.13
|
| Rate for Payer: Vantage Medical Group Senior |
$239.13
|
|
|
HC KIT CATH CNTRL VNS 2.5FR
|
Facility
|
IP
|
$281.33
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$253.20 |
| Rate for Payer: Adventist Health Commercial |
$56.27
|
| Rate for Payer: Blue Shield of California Commercial |
$217.47
|
| Rate for Payer: Blue Shield of California EPN |
$141.79
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Central Health Plan Commercial |
$225.06
|
| Rate for Payer: Cigna of CA HMO |
$196.93
|
| Rate for Payer: Cigna of CA PPO |
$196.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.53
|
| Rate for Payer: EPIC Health Plan Senior |
$112.53
|
| Rate for Payer: Galaxy Health WC |
$239.13
|
| Rate for Payer: Global Benefits Group Commercial |
$168.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.27
|
| Rate for Payer: Multiplan Commercial |
$211.00
|
| Rate for Payer: Networks By Design Commercial |
$140.66
|
| Rate for Payer: Prime Health Services Commercial |
$239.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.58
|
| Rate for Payer: United Healthcare All Other HMO |
$102.77
|
| Rate for Payer: United Healthcare HMO Rider |
$100.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.14
|
|
|
HC KIT CATH CNTRL VNS 3FR SL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC KIT CATH CNTRL VNS 3FR SL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901604826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.56
|
| Rate for Payer: Blue Shield of California Commercial |
$175.36
|
| Rate for Payer: Blue Shield of California EPN |
$114.51
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Central Health Plan Commercial |
$229.60
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$258.30
|
| Rate for Payer: InnovAge PACE Commercial |
$143.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$215.25
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Riverside University Health System MISP |
$114.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.50
|
| Rate for Payer: United Healthcare All Other HMO |
$143.50
|
| Rate for Payer: United Healthcare HMO Rider |
$143.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
