|
HC PELVIMMETRY
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$258.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$352.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.44
|
| Rate for Payer: Blue Shield of California Commercial |
$285.29
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$399.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$399.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: InnovAge PACE Commercial |
$235.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$329.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$329.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Riverside University Health System MISP |
$188.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$399.50
|
| Rate for Payer: Vantage Medical Group Senior |
$399.50
|
|
|
HC PELVIMMETRY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$557.83
|
| Rate for Payer: Blue Shield of California EPN |
$364.84
|
| Rate for Payer: Cash Price |
$505.45
|
| Rate for Payer: Cash Price |
$505.45
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: Cigna of CA HMO |
$588.16
|
| Rate for Payer: Cigna of CA PPO |
$680.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$551.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$551.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Cash Price |
$505.45
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$612.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$568.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.20 |
| Max. Negotiated Rate |
$1,323.90 |
| Rate for Payer: Adventist Health Commercial |
$294.20
|
| Rate for Payer: Cash Price |
$809.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$588.40
|
| Rate for Payer: Galaxy Health WC |
$1,250.35
|
| Rate for Payer: Global Benefits Group Commercial |
$882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,323.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$910.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.20
|
| Rate for Payer: Multiplan Commercial |
$1,103.25
|
| Rate for Payer: Networks By Design Commercial |
$956.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,250.35
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,471.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$1,323.90 |
| Rate for Payer: Adventist Health Commercial |
$294.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$893.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.31
|
| Rate for Payer: Blue Shield of California Commercial |
$892.90
|
| Rate for Payer: Blue Shield of California EPN |
$583.99
|
| Rate for Payer: Cash Price |
$809.05
|
| Rate for Payer: Cash Price |
$809.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,176.80
|
| Rate for Payer: Cigna of CA HMO |
$941.44
|
| Rate for Payer: Cigna of CA PPO |
$1,088.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,250.35
|
| Rate for Payer: Global Benefits Group Commercial |
$882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,323.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,103.25
|
| Rate for Payer: Networks By Design Commercial |
$956.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,250.35
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$882.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$882.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PENILE INJECTION
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$385.40
|
| 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 |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$1,059.85
|
| Rate for Payer: Cash Price |
$1,059.85
|
| Rate for Payer: Cash Price |
$1,059.85
|
| Rate for Payer: Cash Price |
$1,059.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,541.60
|
| Rate for Payer: Cigna of CA HMO |
$1,233.28
|
| Rate for Payer: Cigna of CA PPO |
$1,425.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,637.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,156.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,734.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,445.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,252.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.95
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,156.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$963.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC PENILE INJECTION
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.40 |
| Max. Negotiated Rate |
$1,734.30 |
| Rate for Payer: Adventist Health Commercial |
$385.40
|
| Rate for Payer: Cash Price |
$1,059.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,541.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.80
|
| Rate for Payer: EPIC Health Plan Senior |
$770.80
|
| Rate for Payer: Galaxy Health WC |
$1,637.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,156.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,734.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,192.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.40
|
| Rate for Payer: Multiplan Commercial |
$1,445.25
|
| Rate for Payer: Networks By Design Commercial |
$1,252.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.95
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$790.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,022.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,056.79
|
| Rate for Payer: Blue Shield of California EPN |
$691.18
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,392.80
|
| Rate for Payer: Cigna of CA HMO |
$1,114.24
|
| Rate for Payer: Cigna of CA PPO |
$1,288.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,479.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,566.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,161.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: Networks By Design Commercial |
$1,131.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,479.85
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,044.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,044.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$348.20 |
| Max. Negotiated Rate |
$1,566.90 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,392.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$696.40
|
| Rate for Payer: Galaxy Health WC |
$1,479.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,566.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,161.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$663.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,077.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.20
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: Networks By Design Commercial |
$1,131.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,479.85
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
IP
|
$19,065.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,813.00 |
| Max. Negotiated Rate |
$17,158.50 |
| Rate for Payer: Adventist Health Commercial |
$3,813.00
|
| Rate for Payer: Cash Price |
$10,485.75
|
| Rate for Payer: Central Health Plan Commercial |
$15,252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,626.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,626.00
|
| Rate for Payer: Galaxy Health WC |
$16,205.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11,439.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,158.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,716.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,263.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,801.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,813.00
|
| Rate for Payer: Multiplan Commercial |
$14,298.75
|
| Rate for Payer: Networks By Design Commercial |
$12,392.25
|
| Rate for Payer: Prime Health Services Commercial |
$16,205.25
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
OP
|
$19,065.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,108.05 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,813.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,484.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,485.75
|
| Rate for Payer: Cash Price |
$10,485.75
|
| Rate for Payer: Cash Price |
$10,485.75
|
| Rate for Payer: Central Health Plan Commercial |
$15,252.00
|
| Rate for Payer: Cigna of CA HMO |
$12,201.60
|
| Rate for Payer: Cigna of CA PPO |
$14,108.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$16,205.25
|
| Rate for Payer: Global Benefits Group Commercial |
$11,439.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,158.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,108.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: InnovAge PACE Commercial |
$6,726.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,716.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,813.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,008.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$14,298.75
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$12,392.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Commercial |
$16,205.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,753.06
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$4,932.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,439.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
IP
|
$18,776.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,755.20 |
| Max. Negotiated Rate |
$16,898.40 |
| Rate for Payer: Adventist Health Commercial |
$3,755.20
|
| Rate for Payer: Cash Price |
$10,326.80
|
| Rate for Payer: Central Health Plan Commercial |
$15,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,510.40
|
| Rate for Payer: Galaxy Health WC |
$15,959.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,898.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,523.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,153.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,622.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,755.20
|
| Rate for Payer: Multiplan Commercial |
$14,082.00
|
| Rate for Payer: Networks By Design Commercial |
$12,204.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,959.60
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
OP
|
$18,776.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,593.45 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,755.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,484.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,326.80
|
| Rate for Payer: Cash Price |
$10,326.80
|
| Rate for Payer: Cash Price |
$10,326.80
|
| Rate for Payer: Central Health Plan Commercial |
$15,020.80
|
| Rate for Payer: Cigna of CA HMO |
$12,016.64
|
| Rate for Payer: Cigna of CA PPO |
$13,894.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$15,959.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,265.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,898.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,593.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: InnovAge PACE Commercial |
$6,726.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,523.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,864.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,755.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,008.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$14,082.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$12,204.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Commercial |
$15,959.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,753.06
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$4,932.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,265.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$10,747.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,149.40 |
| Max. Negotiated Rate |
$9,672.30 |
| Rate for Payer: Adventist Health Commercial |
$2,149.40
|
| Rate for Payer: Cash Price |
$5,910.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,597.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,298.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,298.80
|
| Rate for Payer: Galaxy Health WC |
$9,134.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,448.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,672.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,094.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,652.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,149.40
|
| Rate for Payer: Multiplan Commercial |
$8,060.25
|
| Rate for Payer: Networks By Design Commercial |
$6,985.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,134.95
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$10,747.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,498.14 |
| Max. Negotiated Rate |
$9,672.30 |
| Rate for Payer: Adventist Health Commercial |
$2,149.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,498.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,387.03
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,910.85
|
| Rate for Payer: Cash Price |
$5,910.85
|
| Rate for Payer: Cash Price |
$5,910.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,597.60
|
| Rate for Payer: Cigna of CA HMO |
$6,878.08
|
| Rate for Payer: Cigna of CA PPO |
$7,952.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$9,134.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,448.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,672.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,533.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,168.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,693.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,149.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$8,060.25
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$6,985.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Preferred Health Network WC |
$2,435.74
|
| Rate for Payer: Prime Health Services Commercial |
$9,134.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,448.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$179.77 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,202.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,640.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,284.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.51
|
| Rate for Payer: Blue Shield of California EPN |
$868.24
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: Cigna of CA HMO |
$1,399.68
|
| Rate for Payer: Cigna of CA PPO |
$1,618.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,858.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,858.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,093.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.90
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
| Rate for Payer: Riverside University Health System MISP |
$874.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,312.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,093.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,093.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,093.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,858.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,858.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,858.95
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$437.40 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Adventist Health Commercial |
$437.40
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,749.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: EPIC Health Plan Senior |
$874.80
|
| Rate for Payer: Galaxy Health WC |
$1,858.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,968.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,458.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,353.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.40
|
| Rate for Payer: Multiplan Commercial |
$1,640.25
|
| Rate for Payer: Networks By Design Commercial |
$1,421.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,858.95
|
|
|
HC PERC HC TRANSCATH ABLTN PULM ARTERIES RH CATH
|
Facility
|
IP
|
$64,413.00
|
|
|
Service Code
|
CPT 0793T
|
| Hospital Charge Code |
906819786
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,882.60 |
| Max. Negotiated Rate |
$57,971.70 |
| Rate for Payer: Adventist Health Commercial |
$12,882.60
|
| Rate for Payer: Cash Price |
$35,427.15
|
| Rate for Payer: Central Health Plan Commercial |
$51,530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,765.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25,765.20
|
| Rate for Payer: Galaxy Health WC |
$54,751.05
|
| Rate for Payer: Global Benefits Group Commercial |
$38,647.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,971.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42,963.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,541.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39,871.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,882.60
|
| Rate for Payer: Multiplan Commercial |
$48,309.75
|
| Rate for Payer: Networks By Design Commercial |
$41,868.45
|
| Rate for Payer: Prime Health Services Commercial |
$54,751.05
|
|
|
HC PERC HC TRANSCATH ABLTN PULM ARTERIES RH CATH
|
Facility
|
OP
|
$64,413.00
|
|
|
Service Code
|
CPT 0793T
|
| Hospital Charge Code |
906819786
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$57,971.70 |
| Rate for Payer: Adventist Health Commercial |
$12,882.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31,188.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,829.75
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$35,427.15
|
| Rate for Payer: Cash Price |
$35,427.15
|
| Rate for Payer: Cash Price |
$35,427.15
|
| Rate for Payer: Central Health Plan Commercial |
$51,530.40
|
| Rate for Payer: Cigna of CA HMO |
$41,224.32
|
| Rate for Payer: Cigna of CA PPO |
$47,665.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$54,751.05
|
| Rate for Payer: Global Benefits Group Commercial |
$38,647.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,971.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42,963.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,541.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,882.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$48,309.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$41,868.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$54,751.05
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38,647.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,206.50
|
| Rate for Payer: United Healthcare All Other HMO |
$32,206.50
|
| Rate for Payer: United Healthcare HMO Rider |
$32,206.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,206.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.20 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,738.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,738.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,336.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,621.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,770.01
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.80
|
| Rate for Payer: Cigna of CA HMO |
$1,767.04
|
| Rate for Payer: Cigna of CA PPO |
$2,043.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,912.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,738.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,346.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.51
|
| Rate for Payer: Galaxy Health WC |
$2,346.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,851.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$893.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,738.51
|
| Rate for Payer: InnovAge PACE Commercial |
$2,607.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,329.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,329.60
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
| Rate for Payer: Multiplan WC |
$2,770.01
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,738.51
|
| Rate for Payer: Preferred Health Network WC |
$2,826.54
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,842.82
|
| Rate for Payer: Prime Health Services WC |
$2,741.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,912.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,738.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,738.51
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
IP
|
$2,761.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.20 |
| Max. Negotiated Rate |
$2,484.90 |
| Rate for Payer: Adventist Health Commercial |
$552.20
|
| Rate for Payer: Cash Price |
$1,518.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.40
|
| Rate for Payer: Galaxy Health WC |
$2,346.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,841.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,709.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.20
|
| Rate for Payer: Multiplan Commercial |
$2,070.75
|
| Rate for Payer: Networks By Design Commercial |
$1,794.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.85
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
IP
|
$25,085.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906811903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,017.00 |
| Max. Negotiated Rate |
$22,576.50 |
| Rate for Payer: Adventist Health Commercial |
$5,017.00
|
| Rate for Payer: Cash Price |
$13,796.75
|
| Rate for Payer: Central Health Plan Commercial |
$20,068.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,034.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,034.00
|
| Rate for Payer: Galaxy Health WC |
$21,322.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,051.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,576.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,731.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,557.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,527.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,017.00
|
| Rate for Payer: Multiplan Commercial |
$18,813.75
|
| Rate for Payer: Networks By Design Commercial |
$16,305.25
|
| Rate for Payer: Prime Health Services Commercial |
$21,322.25
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
IP
|
$29,512.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,902.40 |
| Max. Negotiated Rate |
$26,560.80 |
| Rate for Payer: Adventist Health Commercial |
$5,902.40
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Central Health Plan Commercial |
$23,609.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,804.80
|
| Rate for Payer: Galaxy Health WC |
$25,085.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,707.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,560.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,684.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,244.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,267.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,902.40
|
| Rate for Payer: Multiplan Commercial |
$22,134.00
|
| Rate for Payer: Networks By Design Commercial |
$19,182.80
|
| Rate for Payer: Prime Health Services Commercial |
$25,085.20
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
OP
|
$29,512.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,069.82 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,902.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Central Health Plan Commercial |
$23,609.60
|
| Rate for Payer: Cigna of CA HMO |
$18,887.68
|
| Rate for Payer: Cigna of CA PPO |
$21,838.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$25,085.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,707.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,560.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,684.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,902.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$22,134.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$19,182.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$25,085.20
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,707.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
