|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
IP
|
$13,769.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,753.80 |
| Max. Negotiated Rate |
$12,392.10 |
| Rate for Payer: Adventist Health Commercial |
$2,753.80
|
| Rate for Payer: Cash Price |
$7,572.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,015.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,507.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,507.60
|
| Rate for Payer: Galaxy Health WC |
$11,703.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,261.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,392.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,183.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,245.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,523.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,753.80
|
| Rate for Payer: Multiplan Commercial |
$10,326.75
|
| Rate for Payer: Networks By Design Commercial |
$8,949.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,703.65
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
OP
|
$13,769.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,753.80 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,753.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$7,572.95
|
| Rate for Payer: Cash Price |
$7,572.95
|
| Rate for Payer: Cash Price |
$7,572.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,015.20
|
| Rate for Payer: Cigna of CA HMO |
$8,812.16
|
| Rate for Payer: Cigna of CA PPO |
$10,189.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$11,703.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,261.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,392.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,784.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,183.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,075.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,753.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$10,326.75
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$8,949.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$11,703.65
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,261.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
OP
|
$6,633.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,326.60 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,326.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$3,840.40
|
| 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 |
$3,648.15
|
| Rate for Payer: Cash Price |
$3,648.15
|
| Rate for Payer: Cash Price |
$3,648.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,306.40
|
| Rate for Payer: Cigna of CA HMO |
$4,245.12
|
| Rate for Payer: Cigna of CA PPO |
$4,908.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$5,638.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,969.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,881.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,078.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,974.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$4,311.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$5,638.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,979.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
IP
|
$6,633.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,326.60 |
| Max. Negotiated Rate |
$5,969.70 |
| Rate for Payer: Adventist Health Commercial |
$1,326.60
|
| Rate for Payer: Cash Price |
$3,648.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,306.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,653.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,653.20
|
| Rate for Payer: Galaxy Health WC |
$5,638.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,979.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,969.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,527.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,105.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.60
|
| Rate for Payer: Multiplan Commercial |
$4,974.75
|
| Rate for Payer: Networks By Design Commercial |
$4,311.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,638.05
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
OP
|
$7,556.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.35 |
| Max. Negotiated Rate |
$6,800.40 |
| Rate for Payer: Adventist Health Commercial |
$1,511.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,588.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.27
|
| Rate for Payer: Blue Shield of California Commercial |
$4,586.49
|
| Rate for Payer: Blue Shield of California EPN |
$2,999.73
|
| Rate for Payer: Cash Price |
$4,155.80
|
| Rate for Payer: Cash Price |
$4,155.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,044.80
|
| Rate for Payer: Cigna of CA HMO |
$4,835.84
|
| Rate for Payer: Cigna of CA PPO |
$5,591.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,422.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,533.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,800.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$212.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,667.00
|
| Rate for Payer: Networks By Design Commercial |
$4,911.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$6,422.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,533.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,533.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
IP
|
$7,556.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,511.20 |
| Max. Negotiated Rate |
$6,800.40 |
| Rate for Payer: Adventist Health Commercial |
$1,511.20
|
| Rate for Payer: Cash Price |
$4,155.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,044.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,022.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,022.40
|
| Rate for Payer: Galaxy Health WC |
$6,422.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,533.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,800.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,878.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,677.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,511.20
|
| Rate for Payer: Multiplan Commercial |
$5,667.00
|
| Rate for Payer: Networks By Design Commercial |
$4,911.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,422.60
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
OP
|
$3,474.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$532.27 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,109.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.27
|
| Rate for Payer: Blue Shield of California Commercial |
$2,108.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,379.18
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,779.20
|
| Rate for Payer: Cigna of CA HMO |
$2,223.36
|
| Rate for Payer: Cigna of CA PPO |
$2,570.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$2,952.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,084.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,126.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,317.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
| Rate for Payer: Networks By Design Commercial |
$2,258.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$2,952.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,084.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,084.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
IP
|
$3,474.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$694.80 |
| Max. Negotiated Rate |
$3,126.60 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Cash Price |
$1,910.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,779.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,389.60
|
| Rate for Payer: Galaxy Health WC |
$2,952.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,084.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,126.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,317.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,323.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,150.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.80
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
| Rate for Payer: Networks By Design Commercial |
$2,258.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,952.90
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
IP
|
$25,260.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,052.00 |
| Max. Negotiated Rate |
$22,734.00 |
| Rate for Payer: Adventist Health Commercial |
$5,052.00
|
| Rate for Payer: Cash Price |
$13,893.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,208.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,104.00
|
| Rate for Payer: Galaxy Health WC |
$21,471.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,734.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,624.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,635.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,052.00
|
| Rate for Payer: Multiplan Commercial |
$18,945.00
|
| Rate for Payer: Networks By Design Commercial |
$16,419.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,471.00
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
OP
|
$25,260.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.93 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,052.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,471.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,893.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,945.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$13,893.00
|
| Rate for Payer: Cash Price |
$13,893.00
|
| Rate for Payer: Cash Price |
$13,893.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,208.00
|
| Rate for Payer: Cigna of CA HMO |
$16,166.40
|
| Rate for Payer: Cigna of CA PPO |
$18,692.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,471.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,471.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,471.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,104.00
|
| Rate for Payer: Galaxy Health WC |
$21,471.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,734.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$163.93
|
| Rate for Payer: InnovAge PACE Commercial |
$12,630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,635.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,052.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,682.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,682.00
|
| Rate for Payer: Multiplan Commercial |
$18,945.00
|
| Rate for Payer: Networks By Design Commercial |
$16,419.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,471.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,471.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,471.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,471.00
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
IP
|
$21,471.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,294.20 |
| Max. Negotiated Rate |
$19,323.90 |
| Rate for Payer: Adventist Health Commercial |
$4,294.20
|
| Rate for Payer: Cash Price |
$11,809.05
|
| Rate for Payer: Central Health Plan Commercial |
$17,176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,588.40
|
| Rate for Payer: Galaxy Health WC |
$18,250.35
|
| Rate for Payer: Global Benefits Group Commercial |
$12,882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,323.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,180.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,290.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,294.20
|
| Rate for Payer: Multiplan Commercial |
$16,103.25
|
| Rate for Payer: Networks By Design Commercial |
$13,956.15
|
| Rate for Payer: Prime Health Services Commercial |
$18,250.35
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
OP
|
$21,471.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.93 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,294.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,250.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,809.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,103.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$11,809.05
|
| Rate for Payer: Cash Price |
$11,809.05
|
| Rate for Payer: Cash Price |
$11,809.05
|
| Rate for Payer: Central Health Plan Commercial |
$17,176.80
|
| Rate for Payer: Cigna of CA HMO |
$13,741.44
|
| Rate for Payer: Cigna of CA PPO |
$15,888.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,250.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,250.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,250.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,588.40
|
| Rate for Payer: Galaxy Health WC |
$18,250.35
|
| Rate for Payer: Global Benefits Group Commercial |
$12,882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,323.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$163.93
|
| Rate for Payer: InnovAge PACE Commercial |
$10,735.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,321.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,290.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,294.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,029.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,029.70
|
| Rate for Payer: Multiplan Commercial |
$16,103.25
|
| Rate for Payer: Networks By Design Commercial |
$13,956.15
|
| Rate for Payer: Prime Health Services Commercial |
$18,250.35
|
| Rate for Payer: Riverside University Health System MISP |
$8,588.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,882.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,250.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,250.35
|
| Rate for Payer: Vantage Medical Group Senior |
$18,250.35
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$11,570.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$10,413.00 |
| Rate for Payer: Adventist Health Commercial |
$2,314.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,834.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,363.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,677.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,602.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,795.06
|
| 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 |
$6,363.50
|
| Rate for Payer: Cash Price |
$6,363.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,256.00
|
| Rate for Payer: Cigna of CA HMO |
$7,404.80
|
| Rate for Payer: Cigna of CA PPO |
$8,561.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,834.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,834.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,834.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,628.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,628.00
|
| Rate for Payer: Galaxy Health WC |
$9,834.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,942.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,413.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,785.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,717.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,161.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,099.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,099.00
|
| Rate for Payer: Multiplan Commercial |
$8,677.50
|
| Rate for Payer: Networks By Design Commercial |
$7,520.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,834.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,628.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,942.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,785.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,785.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,785.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,834.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,834.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,834.50
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$16,477.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,295.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,005.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,062.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,357.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,978.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,676.94
|
| 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 |
$9,062.35
|
| Rate for Payer: Cash Price |
$9,062.35
|
| Rate for Payer: Central Health Plan Commercial |
$13,181.60
|
| Rate for Payer: Cigna of CA HMO |
$10,545.28
|
| Rate for Payer: Cigna of CA PPO |
$12,192.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,005.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,005.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,005.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,590.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,590.80
|
| Rate for Payer: Galaxy Health WC |
$14,005.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,886.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,829.30
|
| Rate for Payer: InnovAge PACE Commercial |
$8,238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,990.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,277.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,199.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,295.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,533.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,533.90
|
| Rate for Payer: Multiplan Commercial |
$12,357.75
|
| Rate for Payer: Networks By Design Commercial |
$10,710.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,005.45
|
| Rate for Payer: Riverside University Health System MISP |
$6,590.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,886.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,005.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,005.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14,005.45
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$16,477.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,295.40 |
| Max. Negotiated Rate |
$14,829.30 |
| Rate for Payer: Adventist Health Commercial |
$3,295.40
|
| Rate for Payer: Cash Price |
$9,062.35
|
| Rate for Payer: Central Health Plan Commercial |
$13,181.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,590.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,590.80
|
| Rate for Payer: Galaxy Health WC |
$14,005.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,886.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,829.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,990.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,277.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,199.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,295.40
|
| Rate for Payer: Multiplan Commercial |
$12,357.75
|
| Rate for Payer: Networks By Design Commercial |
$10,710.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,005.45
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$11,570.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,314.00 |
| Max. Negotiated Rate |
$10,413.00 |
| Rate for Payer: Adventist Health Commercial |
$2,314.00
|
| Rate for Payer: Cash Price |
$6,363.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,256.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,628.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,628.00
|
| Rate for Payer: Galaxy Health WC |
$9,834.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,942.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,413.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,717.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,408.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,161.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Multiplan Commercial |
$8,677.50
|
| Rate for Payer: Networks By Design Commercial |
$7,520.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,834.50
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
OP
|
$22,736.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.04 |
| Max. Negotiated Rate |
$20,462.40 |
| Rate for Payer: Adventist Health Commercial |
$4,547.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| 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 |
$6,568.63
|
| Rate for Payer: Cash Price |
$12,504.80
|
| Rate for Payer: Cash Price |
$12,504.80
|
| Rate for Payer: Cash Price |
$12,504.80
|
| Rate for Payer: Cash Price |
$12,504.80
|
| Rate for Payer: Central Health Plan Commercial |
$18,188.80
|
| Rate for Payer: Cigna of CA HMO |
$14,551.04
|
| Rate for Payer: Cigna of CA PPO |
$16,824.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$19,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,462.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,164.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,547.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$17,052.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$14,778.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$19,325.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,641.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,368.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,368.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,368.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,368.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
IP
|
$22,736.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,547.20 |
| Max. Negotiated Rate |
$20,462.40 |
| Rate for Payer: Adventist Health Commercial |
$4,547.20
|
| Rate for Payer: Cash Price |
$12,504.80
|
| Rate for Payer: Central Health Plan Commercial |
$18,188.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,094.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,094.40
|
| Rate for Payer: Galaxy Health WC |
$19,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,462.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,164.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,662.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,073.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,547.20
|
| Rate for Payer: Multiplan Commercial |
$17,052.00
|
| Rate for Payer: Networks By Design Commercial |
$14,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$19,325.60
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Blue Shield of California Commercial |
$203.30
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.62
|
| Rate for Payer: Blue Shield of California Commercial |
$203.30
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: InnovAge PACE Commercial |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.10
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Riverside University Health System MISP |
$105.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$405.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$405.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| 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 |
$1,424.40
|
| 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 |
$1,114.30
|
| Rate for Payer: Cash Price |
$1,114.30
|
| Rate for Payer: Cash Price |
$1,114.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.80
|
| Rate for Payer: Cigna of CA HMO |
$1,296.64
|
| Rate for Payer: Cigna of CA PPO |
$1,499.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,722.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,823.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,351.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,519.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,316.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.10
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$405.20 |
| Max. Negotiated Rate |
$1,823.40 |
| Rate for Payer: Adventist Health Commercial |
$405.20
|
| Rate for Payer: Cash Price |
$1,114.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.40
|
| Rate for Payer: EPIC Health Plan Senior |
$810.40
|
| Rate for Payer: Galaxy Health WC |
$1,722.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,351.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.20
|
| Rate for Payer: Multiplan Commercial |
$1,519.50
|
| Rate for Payer: Networks By Design Commercial |
$1,316.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.10
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
OP
|
$17,628.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$26,811.67 |
| Rate for Payer: Adventist Health Commercial |
$3,525.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16,348.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,348.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,048.55
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$9,695.40
|
| Rate for Payer: Cash Price |
$9,695.40
|
| Rate for Payer: Cash Price |
$9,695.40
|
| Rate for Payer: Central Health Plan Commercial |
$14,102.40
|
| Rate for Payer: Cigna of CA HMO |
$11,281.92
|
| Rate for Payer: Cigna of CA PPO |
$13,044.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,983.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,348.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,070.58
|
| Rate for Payer: EPIC Health Plan Senior |
$16,348.58
|
| Rate for Payer: Galaxy Health WC |
$14,983.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,576.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,865.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26,811.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,326.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,348.58
|
| Rate for Payer: InnovAge PACE Commercial |
$24,522.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,757.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,988.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,348.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,907.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,907.10
|
| Rate for Payer: Multiplan Commercial |
$13,221.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: Networks By Design Commercial |
$11,458.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,348.58
|
| Rate for Payer: Preferred Health Network WC |
$26,580.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,983.80
|
| Rate for Payer: Prime Health Services Medicare |
$17,329.49
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Riverside University Health System MISP |
$17,983.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,576.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,348.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16,348.58
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
IP
|
$17,628.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,525.60 |
| Max. Negotiated Rate |
$15,865.20 |
| Rate for Payer: Adventist Health Commercial |
$3,525.60
|
| Rate for Payer: Cash Price |
$9,695.40
|
| Rate for Payer: Central Health Plan Commercial |
$14,102.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,051.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,051.20
|
| Rate for Payer: Galaxy Health WC |
$14,983.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,576.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,865.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,757.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,716.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,911.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.60
|
| Rate for Payer: Multiplan Commercial |
$13,221.00
|
| Rate for Payer: Networks By Design Commercial |
$11,458.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,983.80
|
|
|
HC PERCU-STAY
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11.61
|
| Rate for Payer: Blue Shield of California EPN |
$7.58
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: InnovAge PACE Commercial |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.30
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Riverside University Health System MISP |
$7.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Vantage Medical Group Senior |
$16.15
|
|
