|
HC LIQUID COILS
|
Facility
|
IP
|
$1,030.40
|
|
| Hospital Charge Code |
909081813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.08 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Blue Shield of California EPN |
$550.23
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Central Health Plan Commercial |
$824.32
|
| Rate for Payer: Cigna of CA HMO |
$721.28
|
| Rate for Payer: Cigna of CA PPO |
$721.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$412.16
|
| Rate for Payer: Galaxy Health WC |
$875.84
|
| Rate for Payer: Global Benefits Group Commercial |
$618.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.08
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: Prime Health Services Commercial |
$875.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.08
|
| Rate for Payer: United Healthcare All Other HMO |
$380.01
|
| Rate for Payer: United Healthcare HMO Rider |
$371.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.03
|
|
|
HC LITHIUM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC LITHIUM
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$58.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.60
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Caremore Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.92
|
| Rate for Payer: Dignity Health Media |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.61
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.61
|
| Rate for Payer: InnovAge PACE Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.01
|
| Rate for Payer: Riverside University Health System MISP |
$7.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.61
|
|
|
HC LITHIUM ION BATTERY, CHARGER
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT L7368
|
| Hospital Charge Code |
905357368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$765.00 |
| 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 |
$467.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.18
|
| Rate for Payer: Blue Distinction Transplant |
$510.00
|
| Rate for Payer: Blue Shield of California Commercial |
$637.50
|
| Rate for Payer: Blue Shield of California EPN |
$462.40
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Cigna of CA HMO |
$595.00
|
| Rate for Payer: Cigna of CA PPO |
$595.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Media |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$637.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$297.50
|
| 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: LLUH Dept of Risk Management WC |
$348.50
|
| 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 |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO |
$425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$425.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.00
|
| 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: Blue Shield of California EPN |
$453.90
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Cigna of CA HMO |
$595.00
|
| Rate for Payer: Cigna of CA PPO |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$170.00
|
| 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: United Healthcare All Other Commercial |
$320.96
|
| Rate for Payer: United Healthcare All Other HMO |
$313.48
|
| Rate for Payer: United Healthcare HMO Rider |
$306.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.50
|
|
|
HC LITHIUM ION BATTERY, REPLACMNT
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
CPT L7367
|
| Hospital Charge Code |
905357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.55 |
| Max. Negotiated Rate |
$551.70 |
| 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 |
$337.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$296.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.16
|
| Rate for Payer: Blue Distinction Transplant |
$367.80
|
| Rate for Payer: Blue Shield of California Commercial |
$459.75
|
| Rate for Payer: Blue Shield of California EPN |
$333.47
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.05
|
| Rate for Payer: Dignity Health Media |
$521.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$459.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$214.55
|
| 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: LLUH Dept of Risk Management WC |
$251.33
|
| 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 |
$306.50
|
| Rate for Payer: United Healthcare All Other HMO |
$306.50
|
| Rate for Payer: United Healthcare HMO Rider |
$306.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.50
|
| 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 |
905357367
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$551.70 |
| Rate for Payer: Blue Shield of California EPN |
$327.34
|
| Rate for Payer: Cash Price |
$275.85
|
| Rate for Payer: Central Health Plan Commercial |
$490.40
|
| Rate for Payer: Cigna of CA HMO |
$429.10
|
| Rate for Payer: Cigna of CA PPO |
$429.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$122.60
|
| 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: United Healthcare All Other Commercial |
$231.47
|
| Rate for Payer: United Healthcare All Other HMO |
$226.07
|
| Rate for Payer: United Healthcare HMO Rider |
$221.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.29
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: Blue Distinction Transplant |
$29,497.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Central Health Plan Commercial |
$39,329.60
|
| Rate for Payer: Cigna of CA PPO |
$36,379.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$41,787.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,497.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,245.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36,871.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,791.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,832.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$31,955.30
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$41,787.70
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,497.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,832.40 |
| Max. Negotiated Rate |
$44,245.80 |
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Central Health Plan Commercial |
$39,329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,664.80
|
| Rate for Payer: Galaxy Health WC |
$41,787.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,497.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,245.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,791.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,730.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,832.40
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
| Rate for Payer: Networks By Design Commercial |
$31,955.30
|
| Rate for Payer: Prime Health Services Commercial |
$41,787.70
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
IP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906819767
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,832.40 |
| Max. Negotiated Rate |
$44,245.80 |
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Central Health Plan Commercial |
$39,329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,664.80
|
| Rate for Payer: Galaxy Health WC |
$41,787.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,497.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,245.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,791.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,730.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,832.40
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
| Rate for Payer: Networks By Design Commercial |
$31,955.30
|
| Rate for Payer: Prime Health Services Commercial |
$41,787.70
|
|
|
HC LITHOTRIPSY STENT ATHERECTOMY
|
Facility
|
OP
|
$49,162.00
|
|
|
Service Code
|
CPT C9767
|
| Hospital Charge Code |
906820315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: Blue Distinction Transplant |
$29,497.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Cash Price |
$22,122.90
|
| Rate for Payer: Central Health Plan Commercial |
$39,329.60
|
| Rate for Payer: Cigna of CA PPO |
$36,379.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$41,787.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,497.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$44,245.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36,871.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,791.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,832.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$36,871.50
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$31,955.30
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$41,787.70
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,497.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
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: Aetna of CA HMO/PPO |
$24,530.71
|
| 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 |
$43,612.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$47,577.60
|
| Rate for Payer: Blue Shield of California Commercial |
$49,877.18
|
| Rate for Payer: Blue Shield of California EPN |
$38,775.74
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Cigna of CA HMO |
$50,749.44
|
| Rate for Payer: Cigna of CA PPO |
$58,679.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Dignity Health Media |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$59,472.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,753.60
|
| 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: 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
|
| 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 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 |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Tricare |
$79,296.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,001.60 |
| Max. Negotiated Rate |
$4,507.20 |
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,003.20
|
| Rate for Payer: Galaxy Health WC |
$4,256.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,507.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,340.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,908.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.60
|
| Rate for Payer: Multiplan Commercial |
$3,756.00
|
| Rate for Payer: Networks By Design Commercial |
$3,255.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,256.80
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$319.73 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,004.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,006.40
|
| Rate for Payer: Cigna of CA PPO |
$3,705.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,256.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,507.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,756.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,340.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,756.00
|
| Rate for Payer: Networks By Design Commercial |
$3,255.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,256.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,004.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,430.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,001.60 |
| Max. Negotiated Rate |
$4,507.20 |
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,006.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,003.20
|
| Rate for Payer: Galaxy Health WC |
$4,256.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,507.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,340.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,908.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.60
|
| Rate for Payer: Multiplan Commercial |
$3,756.00
|
| Rate for Payer: Networks By Design Commercial |
$3,255.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,256.80
|
|
|
HC LIVER BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
909000140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$319.73 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,004.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,094.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,433.89
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,006.40
|
| Rate for Payer: Cigna of CA HMO |
$3,205.12
|
| Rate for Payer: Cigna of CA PPO |
$3,705.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,256.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,507.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,756.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,340.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,001.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,756.00
|
| Rate for Payer: Networks By Design Commercial |
$3,255.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,256.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,004.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,004.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,504.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,504.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,504.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$684.90 |
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC LIVER BIOPSY W OTHER PROC
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
909000141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$646.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$418.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$456.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Central Health Plan Commercial |
$608.80
|
| Rate for Payer: Cigna of CA PPO |
$563.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$646.85
|
| Rate for Payer: Dignity Health Media |
$646.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$646.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$684.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$570.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.20
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
| Rate for Payer: Riverside University Health System MISP |
$304.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$646.85
|
| Rate for Payer: Vantage Medical Group Senior |
$646.85
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
OP
|
$2,015.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,813.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$940.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$604.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,190.46
|
| Rate for Payer: Blue Distinction Transplant |
$1,209.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,245.27
|
| Rate for Payer: Blue Shield of California EPN |
$979.29
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$906.75
|
| Rate for Payer: Cash Price |
$906.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,612.00
|
| Rate for Payer: Cigna of CA HMO |
$1,289.60
|
| Rate for Payer: Cigna of CA PPO |
$1,491.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,712.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,209.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,813.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,511.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,344.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,511.25
|
| Rate for Payer: Networks By Design Commercial |
$1,309.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,712.75
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,209.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,209.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LIVER/SPLEEN SCAN
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
909301351
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$1,813.50 |
| Rate for Payer: Cash Price |
$906.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$806.00
|
| Rate for Payer: Galaxy Health WC |
$1,712.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,209.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,813.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,344.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.00
|
| Rate for Payer: Multiplan Commercial |
$1,511.25
|
| Rate for Payer: Networks By Design Commercial |
$1,309.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,712.75
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
OP
|
$2,663.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$216.22 |
| Max. Negotiated Rate |
$2,396.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$575.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$718.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,573.30
|
| Rate for Payer: Blue Distinction Transplant |
$1,597.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,645.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,294.22
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,130.40
|
| Rate for Payer: Cigna of CA HMO |
$1,704.32
|
| Rate for Payer: Cigna of CA PPO |
$1,970.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,263.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,396.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,997.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,776.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,997.25
|
| Rate for Payer: Networks By Design Commercial |
$1,730.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,263.55
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,597.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,597.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LIVER/SPLEEN VAS FLO
|
Facility
|
IP
|
$2,663.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
909301352
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$532.60 |
| Max. Negotiated Rate |
$2,396.70 |
| Rate for Payer: Cash Price |
$1,198.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,130.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,065.20
|
| Rate for Payer: Galaxy Health WC |
$2,263.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,597.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,396.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,776.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.60
|
| Rate for Payer: Multiplan Commercial |
$1,997.25
|
| Rate for Payer: Networks By Design Commercial |
$1,730.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,263.55
|
|
|
HC LMA AIRWARY
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$368.10 |
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.60
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
|
|
HC LMA AIRWARY
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800911
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.64
|
| Rate for Payer: Blue Distinction Transplant |
$245.40
|
| Rate for Payer: Blue Shield of California Commercial |
$252.76
|
| Rate for Payer: Blue Shield of California EPN |
$198.77
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Cigna of CA HMO |
$261.76
|
| Rate for Payer: Cigna of CA PPO |
$302.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$306.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
