|
HC LITHIUM ION BATTERY, CHARGER
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT L7368
|
| Hospital Charge Code |
915357368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.38 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$637.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.20
|
| Rate for Payer: Blue Shield of California Commercial |
$657.05
|
| Rate for Payer: Blue Shield of California EPN |
$428.40
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| 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: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$722.50
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$546.74
|
| Rate for Payer: InnovAge PACE Commercial |
$425.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$425.00
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Riverside University Health System MISP |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.00
|
| 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 HMO Rider |
$303.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC LITHIUM ION BATTERY, CHARGER
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT L7368
|
| Hospital Charge Code |
905357368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.38 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$637.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.20
|
| Rate for Payer: Blue Shield of California Commercial |
$657.05
|
| Rate for Payer: Blue Shield of California EPN |
$428.40
|
| Rate for Payer: Cash Price |
$467.50
|
| Rate for Payer: Cash Price |
$467.50
|
| 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: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$722.50
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$546.74
|
| Rate for Payer: InnovAge PACE Commercial |
$425.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$425.00
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Riverside University Health System MISP |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.00
|
| 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 HMO Rider |
$303.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC LITHIUM ION BATTERY, CHARGER
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT L7368
|
| Hospital Charge Code |
905357368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Blue Shield of California Commercial |
$657.05
|
| Rate for Payer: Blue Shield of California EPN |
$428.40
|
| Rate for Payer: Cash Price |
$467.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.15
|
| 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 HMO Rider |
$303.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.38
|
|
|
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 |
$360.01
|
| Rate for Payer: Blue Shield of California Commercial |
$473.85
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Cash Price |
$337.15
|
| Rate for Payer: Cash Price |
$337.15
|
| 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: 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: InnovAge PACE Commercial |
$306.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.10
|
| Rate for Payer: Molina Healthcare of CA 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 |
$360.01
|
| Rate for Payer: Blue Shield of California Commercial |
$473.85
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Cash Price |
$337.15
|
| Rate for Payer: Cash Price |
$337.15
|
| 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: 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: InnovAge PACE Commercial |
$306.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.10
|
| Rate for Payer: Molina Healthcare of CA 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
|
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: Adventist Health Commercial |
$122.60
|
| Rate for Payer: Blue Shield of California Commercial |
$473.85
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Cash Price |
$337.15
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.45
|
| 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 |
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 |
$473.85
|
| Rate for Payer: Blue Shield of California EPN |
$308.95
|
| Rate for Payer: Cash Price |
$337.15
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.45
|
| 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 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 |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,221.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,314.64
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$21,833.90
|
| Rate for Payer: Cash Price |
$21,833.90
|
| Rate for Payer: Cash Price |
$21,833.90
|
| 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 |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| 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 |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26,478.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,939.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| 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 |
$22,815.81
|
| 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 |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,818.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$46,704.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,340.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,614.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,429.26
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Central Health Plan Commercial |
$37,363.20
|
| Rate for Payer: Cigna of CA HMO |
$29,890.56
|
| Rate for Payer: Cigna of CA PPO |
$34,560.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$39,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$28,022.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,033.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,151.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,340.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$35,028.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$30,357.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$39,698.40
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,022.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
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 |
$21,833.90
|
| Rate for Payer: Central Health Plan Commercial |
$31,758.40
|
| 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 Permanente of CA Commercial/Self Funded |
$26,478.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,124.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,573.06
|
| 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
|
IP
|
$46,704.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,340.80 |
| Max. Negotiated Rate |
$42,033.60 |
| Rate for Payer: Adventist Health Commercial |
$9,340.80
|
| Rate for Payer: Cash Price |
$25,687.20
|
| Rate for Payer: Central Health Plan Commercial |
$37,363.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,681.60
|
| Rate for Payer: Galaxy Health WC |
$39,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$28,022.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,033.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,151.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,794.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,909.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,340.80
|
| Rate for Payer: Multiplan Commercial |
$35,028.00
|
| Rate for Payer: Networks By Design Commercial |
$30,357.60
|
| Rate for Payer: Prime Health Services Commercial |
$39,698.40
|
|
|
HC LITHOTRIPTER SURGICAL
|
Facility
|
IP
|
$1,641.50
|
|
| Hospital Charge Code |
900100324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$1,477.35 |
| Rate for Payer: Adventist Health Commercial |
$328.30
|
| Rate for Payer: Cash Price |
$902.82
|
| Rate for Payer: Central Health Plan Commercial |
$1,313.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.60
|
| Rate for Payer: EPIC Health Plan Senior |
$656.60
|
| Rate for Payer: Galaxy Health WC |
$1,395.28
|
| Rate for Payer: Global Benefits Group Commercial |
$984.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,477.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,094.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,016.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$1,231.12
|
| Rate for Payer: Networks By Design Commercial |
$1,066.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,395.28
|
|
|
HC LITHOTRIPTER SURGICAL
|
Facility
|
OP
|
$1,641.50
|
|
| Hospital Charge Code |
900100324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$1,477.35 |
| Rate for Payer: Adventist Health Commercial |
$328.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$996.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,395.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$902.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,231.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$794.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$964.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,002.96
|
| Rate for Payer: Blue Shield of California EPN |
$654.96
|
| Rate for Payer: Cash Price |
$902.82
|
| Rate for Payer: Central Health Plan Commercial |
$1,313.20
|
| Rate for Payer: Cigna of CA HMO |
$1,050.56
|
| Rate for Payer: Cigna of CA PPO |
$1,214.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,395.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,395.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,395.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$656.60
|
| Rate for Payer: EPIC Health Plan Senior |
$656.60
|
| Rate for Payer: Galaxy Health WC |
$1,395.28
|
| Rate for Payer: Global Benefits Group Commercial |
$984.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,477.35
|
| Rate for Payer: InnovAge PACE Commercial |
$820.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,094.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$625.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,016.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,149.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,149.05
|
| Rate for Payer: Multiplan Commercial |
$1,231.12
|
| Rate for Payer: Networks By Design Commercial |
$1,066.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,395.28
|
| Rate for Payer: Riverside University Health System MISP |
$656.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$984.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$984.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$820.75
|
| Rate for Payer: United Healthcare All Other HMO |
$820.75
|
| Rate for Payer: United Healthcare HMO Rider |
$820.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$820.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,395.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,395.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,395.28
|
|
|
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 |
$48,156.46
|
| 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 |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$48,449.86
|
| Rate for Payer: Blue Shield of California EPN |
$31,639.10
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Cash Price |
$43,612.80
|
| 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: 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: InnovAge PACE Commercial |
$39,648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,519.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,084.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,507.20
|
| Rate for Payer: Molina Healthcare of CA 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: United Healthcare All Other Commercial |
$39,648.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,648.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39,648.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39,648.00
|
| 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 |
$43,612.80
|
| Rate for Payer: Cash Price |
$43,612.80
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| 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 Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,084.22
|
| 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
|
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 |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| 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 Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,099.64
|
| 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
|
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 |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| 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 Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,099.64
|
| 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
|
750
|
| Min. Negotiated Rate |
$289.44 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| 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 |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| 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 |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| 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 |
$2,058.68
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,470.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
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 |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,020.16
|
| Rate for Payer: Blue Shield of California EPN |
$2,629.33
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| 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 |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| 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 |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| 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 |
$2,058.68
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
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 |
$553.30
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| 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 Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.71
|
| 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 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$487.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.82
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| 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: 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: InnovAge PACE Commercial |
$503.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$622.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$704.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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 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 |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$217.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.73
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: Cash Price |
$228.25
|
| Rate for Payer: Cash Price |
$228.25
|
| 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 |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| 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 |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| 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 |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.56
|
| 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 |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
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 |
$228.25
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| 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 Permanente of CA Commercial/Self Funded |
$276.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.88
|
| 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
|
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 |
$1,179.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,715.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,430.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,327.14
|
| 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 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 |
$1,038.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,259.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,301.41
|
| Rate for Payer: Blue Shield of California EPN |
$851.17
|
| Rate for Payer: Cash Price |
$1,179.20
|
| 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: 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: InnovAge PACE Commercial |
$1,072.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,430.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,327.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.80
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
