|
HC NEONATAL RESUSCITATION
|
Facility
|
OP
|
$8,146.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$231.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$709.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,944.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,812.66
|
| Rate for Payer: Blue Distinction Transplant |
$4,887.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$3,665.70
|
| Rate for Payer: Cash Price |
$3,665.70
|
| Rate for Payer: Cash Price |
$3,665.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,516.80
|
| Rate for Payer: Cigna of CA HMO |
$5,213.44
|
| Rate for Payer: Cigna of CA PPO |
$6,028.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$6,924.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,887.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,331.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,109.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,433.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$6,109.50
|
| Rate for Payer: Networks By Design Commercial |
$5,294.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,924.10
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,887.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,887.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
|
IP
|
$8,146.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,629.20 |
| Max. Negotiated Rate |
$7,331.40 |
| Rate for Payer: Cash Price |
$3,665.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,516.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,258.40
|
| Rate for Payer: Galaxy Health WC |
$6,924.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,887.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,331.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,433.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,103.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,629.20
|
| Rate for Payer: Multiplan Commercial |
$6,109.50
|
| Rate for Payer: Networks By Design Commercial |
$5,294.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,924.10
|
|
|
HC NEO-TEE IN-LINE CONTROLLER
|
Facility
|
IP
|
$162.26
|
|
| Hospital Charge Code |
901608102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$146.03 |
| Rate for Payer: Cash Price |
$73.02
|
| Rate for Payer: Central Health Plan Commercial |
$129.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: Galaxy Health WC |
$137.92
|
| Rate for Payer: Global Benefits Group Commercial |
$97.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.45
|
| Rate for Payer: Multiplan Commercial |
$121.70
|
| Rate for Payer: Networks By Design Commercial |
$105.47
|
| Rate for Payer: Prime Health Services Commercial |
$137.92
|
|
|
HC NEO-TEE IN-LINE CONTROLLER
|
Facility
|
OP
|
$162.26
|
|
| Hospital Charge Code |
901608102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$146.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.86
|
| Rate for Payer: Blue Distinction Transplant |
$97.36
|
| Rate for Payer: Blue Shield of California Commercial |
$102.06
|
| Rate for Payer: Blue Shield of California EPN |
$79.35
|
| Rate for Payer: Cash Price |
$73.02
|
| Rate for Payer: Central Health Plan Commercial |
$129.81
|
| Rate for Payer: Cigna of CA HMO |
$103.85
|
| Rate for Payer: Cigna of CA PPO |
$120.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.92
|
| Rate for Payer: Dignity Health Media |
$137.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.90
|
| Rate for Payer: Galaxy Health WC |
$137.92
|
| Rate for Payer: Global Benefits Group Commercial |
$97.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$121.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.45
|
| Rate for Payer: Multiplan Commercial |
$121.70
|
| Rate for Payer: Networks By Design Commercial |
$105.47
|
| Rate for Payer: Prime Health Services Commercial |
$137.92
|
| Rate for Payer: Riverside University Health System MISP |
$64.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.13
|
| Rate for Payer: United Healthcare All Other HMO |
$81.13
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.92
|
| Rate for Payer: Vantage Medical Group Senior |
$137.92
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.78
|
| Rate for Payer: Blue Distinction Transplant |
$187.20
|
| Rate for Payer: Blue Shield of California Commercial |
$234.00
|
| Rate for Payer: Blue Shield of California EPN |
$169.73
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Media |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$234.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Riverside University Health System MISP |
$124.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Blue Shield of California EPN |
$166.61
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.81
|
| Rate for Payer: United Healthcare All Other HMO |
$115.07
|
| Rate for Payer: United Healthcare HMO Rider |
$112.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.96
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
OP
|
$4,486.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.72 |
| Max. Negotiated Rate |
$4,199.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$655.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.50
|
| Rate for Payer: Blue Distinction Transplant |
$2,691.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,772.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,180.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.80
|
| Rate for Payer: Cigna of CA HMO |
$2,871.04
|
| Rate for Payer: Cigna of CA PPO |
$3,319.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,037.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,364.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$3,364.50
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,691.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,691.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,132.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3,132.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3,132.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,132.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
IP
|
$4,486.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$4,037.40 |
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.40
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,037.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.20
|
| Rate for Payer: Multiplan Commercial |
$3,364.50
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$6,625.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,962.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,975.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,300.00
|
| Rate for Payer: Cigna of CA PPO |
$4,902.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$5,631.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,962.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,968.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,418.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,325.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$4,968.75
|
| Rate for Payer: Networks By Design Commercial |
$4,306.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,631.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,975.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,312.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,312.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,312.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,312.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$6,625.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$825.30 |
| Max. Negotiated Rate |
$5,962.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,094.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,219.75
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,300.00
|
| Rate for Payer: Cigna of CA HMO |
$4,240.00
|
| Rate for Payer: Cigna of CA PPO |
$4,902.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$5,631.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,962.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,968.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,418.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,325.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$4,968.75
|
| Rate for Payer: Networks By Design Commercial |
$4,306.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,631.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,975.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,975.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,312.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,312.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,312.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,312.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$6,625.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,325.00 |
| Max. Negotiated Rate |
$5,962.50 |
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,650.00
|
| Rate for Payer: Galaxy Health WC |
$5,631.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,962.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,418.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,524.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,325.00
|
| Rate for Payer: Multiplan Commercial |
$4,968.75
|
| Rate for Payer: Networks By Design Commercial |
$4,306.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,631.25
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$6,625.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,325.00 |
| Max. Negotiated Rate |
$5,962.50 |
| Rate for Payer: Cash Price |
$2,981.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,650.00
|
| Rate for Payer: Galaxy Health WC |
$5,631.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,962.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,418.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,524.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,325.00
|
| Rate for Payer: Multiplan Commercial |
$4,968.75
|
| Rate for Payer: Networks By Design Commercial |
$4,306.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,631.25
|
|
|
HC NERVE TEASING
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Central Health Plan Commercial |
$542.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.20
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: Networks By Design Commercial |
$440.70
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
|
|
HC NERVE TEASING
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$1,772.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.31
|
| Rate for Payer: Blue Distinction Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$183.55
|
| Rate for Payer: Blue Shield of California EPN |
$144.34
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: InnovAge PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC NERVOUS SYSTEM PROC
|
Facility
|
IP
|
$7,751.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
907201138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,550.20 |
| Max. Negotiated Rate |
$6,975.90 |
| Rate for Payer: Cash Price |
$3,487.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,200.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,100.40
|
| Rate for Payer: Galaxy Health WC |
$6,588.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,650.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,975.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,169.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,953.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,550.20
|
| Rate for Payer: Multiplan Commercial |
$5,813.25
|
| Rate for Payer: Networks By Design Commercial |
$5,038.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,588.35
|
|
|
HC NERVOUS SYSTEM PROC
|
Facility
|
OP
|
$7,751.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
907201138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.06 |
| Max. Negotiated Rate |
$6,975.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,753.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,579.29
|
| Rate for Payer: Blue Distinction Transplant |
$4,650.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$3,487.95
|
| Rate for Payer: Cash Price |
$3,487.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,200.80
|
| Rate for Payer: Cigna of CA PPO |
$5,735.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$6,588.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,650.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,975.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,813.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,169.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,550.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$5,813.25
|
| Rate for Payer: Networks By Design Commercial |
$5,038.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,588.35
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$699.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: Cigna of CA HMO |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$862.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$873.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.00
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$699.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: Cigna of CA HMO |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$862.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$873.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$1,048.50 |
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Central Health Plan Commercial |
$932.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.00
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,048.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$873.75
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Central Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC NEUROINTERVENTIONAL CATH J&J
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$188.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.53
|
| Rate for Payer: Blue Distinction Transplant |
$82.80
|
| Rate for Payer: Blue Shield of California Commercial |
$86.80
|
| Rate for Payer: Blue Shield of California EPN |
$67.48
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Central Health Plan Commercial |
$110.40
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Media |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$103.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Riverside University Health System MISP |
$55.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69.00
|
| Rate for Payer: United Healthcare HMO Rider |
$69.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$7,787.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,557.40 |
| Max. Negotiated Rate |
$7,008.30 |
| Rate for Payer: Cash Price |
$3,504.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,229.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,114.80
|
| Rate for Payer: Galaxy Health WC |
$6,618.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,008.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,966.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.40
|
| Rate for Payer: Multiplan Commercial |
$5,840.25
|
| Rate for Payer: Networks By Design Commercial |
$5,061.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,618.95
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
IP
|
$7,787.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,557.40 |
| Max. Negotiated Rate |
$7,008.30 |
| Rate for Payer: Cash Price |
$3,504.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,229.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,114.80
|
| Rate for Payer: Galaxy Health WC |
$6,618.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,008.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,966.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.40
|
| Rate for Payer: Multiplan Commercial |
$5,840.25
|
| Rate for Payer: Networks By Design Commercial |
$5,061.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,618.95
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
|
OP
|
$4,271.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.24 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,562.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,416.80
|
| Rate for Payer: Cigna of CA PPO |
$3,160.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$3,630.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,562.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,843.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,203.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,848.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$854.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$3,203.25
|
| Rate for Payer: Networks By Design Commercial |
$2,776.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,630.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,562.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
