|
HC PALINDROME DIALYS 19CM
|
Facility
|
OP
|
$1,959.78
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.96 |
| Max. Negotiated Rate |
$2,565.15 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,565.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,665.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,077.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,469.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$948.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.50
|
| Rate for Payer: Blue Shield of California EPN |
$781.95
|
| Rate for Payer: Cash Price |
$881.90
|
| Rate for Payer: Cash Price |
$881.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,567.82
|
| Rate for Payer: Cigna of CA HMO |
$1,254.26
|
| Rate for Payer: Cigna of CA PPO |
$1,450.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,665.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,665.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,371.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.91
|
| Rate for Payer: EPIC Health Plan Senior |
$783.91
|
| Rate for Payer: Galaxy Health WC |
$1,665.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1,175.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,763.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,244.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$711.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,156.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,371.85
|
| Rate for Payer: Multiplan Commercial |
$1,469.84
|
| Rate for Payer: Networks By Design Commercial |
$1,273.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,665.81
|
| Rate for Payer: Riverside University Health System MISP |
$783.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,175.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,175.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.89
|
| Rate for Payer: United Healthcare All Other HMO |
$979.89
|
| Rate for Payer: United Healthcare HMO Rider |
$979.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$979.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,665.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,665.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.81
|
|
|
HC PALINDROME DIALYS 19CM
|
Facility
|
IP
|
$1,959.78
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.96 |
| Max. Negotiated Rate |
$1,763.80 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Cash Price |
$881.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,567.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,371.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.91
|
| Rate for Payer: EPIC Health Plan Senior |
$783.91
|
| Rate for Payer: Galaxy Health WC |
$1,665.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1,175.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,763.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,244.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,156.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.96
|
| Rate for Payer: Multiplan Commercial |
$1,469.84
|
| Rate for Payer: Networks By Design Commercial |
$1,273.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,665.81
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$4,661.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$651.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$932.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,728.80
|
| Rate for Payer: Cigna of CA HMO |
$2,983.04
|
| Rate for Payer: Cigna of CA PPO |
$3,449.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,262.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$3,961.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,796.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,194.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$651.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,959.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$719.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$932.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$3,495.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,029.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,961.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,796.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,330.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$4,661.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$932.20 |
| Max. Negotiated Rate |
$4,194.90 |
| Rate for Payer: Adventist Health Commercial |
$932.20
|
| Rate for Payer: Cash Price |
$2,097.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,728.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,262.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,864.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,864.40
|
| Rate for Payer: Galaxy Health WC |
$3,961.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,796.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,194.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,959.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,749.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$932.20
|
| Rate for Payer: Multiplan Commercial |
$3,495.75
|
| Rate for Payer: Networks By Design Commercial |
$3,029.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,961.85
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$605.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,142.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,372.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$727.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,888.00
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,124.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$793.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,092.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,092.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$625.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,888.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$944.00
|
| Rate for Payer: EPIC Health Plan Senior |
$944.00
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,124.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,392.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
|
|
HC PANCREATIC PSDOCYST EXT DRN
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$855.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$219.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$241.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Riverside University Health System MISP |
$402.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| 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 PANCREATIC PSDOCYST EXT DRN
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$905.40 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Central Health Plan Commercial |
$804.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$704.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$905.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$638.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$593.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC PANTIES
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$27.27
|
| Rate for Payer: Blue Shield of California EPN |
$17.14
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Riverside University Health System MISP |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC PANTIES
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California Commercial |
$27.27
|
| Rate for Payer: Blue Shield of California EPN |
$17.14
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
|
|
HC PANTIES
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.78
|
| Rate for Payer: Blue Shield of California Commercial |
$27.27
|
| Rate for Payer: Blue Shield of California EPN |
$17.14
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Riverside University Health System MISP |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC PANTIES
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Blue Shield of California Commercial |
$27.27
|
| Rate for Payer: Blue Shield of California EPN |
$17.14
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
|
|
HC PAPOOSE INFANT SPINAL IMOBLIZR
|
Facility
|
IP
|
$1,283.86
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901606308
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.77 |
| Max. Negotiated Rate |
$1,155.47 |
| Rate for Payer: Adventist Health Commercial |
$256.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,029.66
|
| Rate for Payer: Blue Shield of California EPN |
$647.07
|
| Rate for Payer: Cash Price |
$577.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,027.09
|
| Rate for Payer: Cigna of CA HMO |
$898.70
|
| Rate for Payer: Cigna of CA PPO |
$898.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$898.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.54
|
| Rate for Payer: EPIC Health Plan Senior |
$513.54
|
| Rate for Payer: Galaxy Health WC |
$1,091.28
|
| Rate for Payer: Global Benefits Group Commercial |
$770.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$815.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$757.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.77
|
| Rate for Payer: Multiplan Commercial |
$962.89
|
| Rate for Payer: Networks By Design Commercial |
$834.51
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.83
|
| Rate for Payer: United Healthcare All Other HMO |
$468.99
|
| Rate for Payer: United Healthcare HMO Rider |
$458.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.46
|
|
|
HC PAPOOSE INFANT SPINAL IMOBLIZR
|
Facility
|
OP
|
$1,283.86
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901606308
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$314.64 |
| Max. Negotiated Rate |
$1,155.47 |
| Rate for Payer: Adventist Health Commercial |
$526.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,091.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$706.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$962.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,029.66
|
| Rate for Payer: Blue Shield of California EPN |
$647.07
|
| Rate for Payer: Cash Price |
$577.74
|
| Rate for Payer: Cash Price |
$577.74
|
| Rate for Payer: Central Health Plan Commercial |
$1,027.09
|
| Rate for Payer: Cigna of CA HMO |
$898.70
|
| Rate for Payer: Cigna of CA PPO |
$898.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,091.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,091.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,091.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$898.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.54
|
| Rate for Payer: EPIC Health Plan Senior |
$513.54
|
| Rate for Payer: Galaxy Health WC |
$1,091.28
|
| Rate for Payer: Global Benefits Group Commercial |
$770.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$314.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$815.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$757.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$898.70
|
| Rate for Payer: Multiplan Commercial |
$962.89
|
| Rate for Payer: Networks By Design Commercial |
$641.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,091.28
|
| Rate for Payer: Riverside University Health System MISP |
$513.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$770.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$770.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.83
|
| Rate for Payer: United Healthcare All Other HMO |
$468.99
|
| Rate for Payer: United Healthcare HMO Rider |
$458.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,091.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,091.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,091.28
|
|
|
HC PAP S EAR-THIN PREP PG
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800211
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$148.67 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.99
|
| Rate for Payer: Blue Shield of California Commercial |
$37.17
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.43
|
| Rate for Payer: EPIC Health Plan Senior |
$22.29
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.15
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.26
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$21.48
|
| Rate for Payer: Riverside University Health System MISP |
$22.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
HC PAP S EAR-THIN PREP PG
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800211
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC PAP SMEAR-CONVENTIONAL PG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800212
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC PAP SMEAR-CONVENTIONAL PG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800212
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$77.56 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.54
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$19.65
|
| Rate for Payer: Riverside University Health System MISP |
$20.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC PARACENTESIS EYE RML BLOOD
|
Facility
|
OP
|
$9,345.00
|
|
|
Service Code
|
CPT 65815
|
| Hospital Charge Code |
950442303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,410.50 |
| Rate for Payer: Adventist Health Commercial |
$1,869.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$4,205.25
|
| Rate for Payer: Cash Price |
$4,205.25
|
| Rate for Payer: Cash Price |
$4,205.25
|
| Rate for Payer: Cash Price |
$4,205.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.00
|
| Rate for Payer: Cigna of CA HMO |
$5,980.80
|
| Rate for Payer: Cigna of CA PPO |
$6,915.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,541.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$7,943.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,410.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$7,008.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$6,074.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$7,943.25
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,672.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,672.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,672.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC PARACENTESIS EYE RML BLOOD
|
Facility
|
IP
|
$9,345.00
|
|
|
Service Code
|
CPT 65815
|
| Hospital Charge Code |
950442303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,869.00 |
| Max. Negotiated Rate |
$8,410.50 |
| Rate for Payer: EPIC Health Plan Senior |
$3,738.00
|
| Rate for Payer: Galaxy Health WC |
$7,943.25
|
| Rate for Payer: Adventist Health Commercial |
$1,869.00
|
| Rate for Payer: Cash Price |
$4,205.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,541.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,410.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,513.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.00
|
| Rate for Payer: Multiplan Commercial |
$7,008.75
|
| Rate for Payer: Networks By Design Commercial |
$6,074.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,943.25
|
|
|
HC PARA CERVICAL BLOCK
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
904000015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$399.20 |
| Max. Negotiated Rate |
$1,796.40 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,596.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,397.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.40
|
| Rate for Payer: EPIC Health Plan Senior |
$798.40
|
| Rate for Payer: Galaxy Health WC |
$1,696.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,796.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,267.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,177.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.20
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
| Rate for Payer: Networks By Design Commercial |
$1,297.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,696.60
|
|
|
HC PARA CERVICAL BLOCK
|
Facility
|
OP
|
$1,996.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
904000015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,596.80
|
| Rate for Payer: Cigna of CA HMO |
$1,277.44
|
| Rate for Payer: Cigna of CA PPO |
$1,477.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,397.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$1,696.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,796.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,267.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,297.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,696.60
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,197.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC PARAFFIN BATH OT
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
905104109
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Riverside University Health System MISP |
$94.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC PARAFFIN BATH OT
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
905104109
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC PARAFFIN BATH PT
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 97018
|
| Hospital Charge Code |
905103109
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
