|
HC PERCU-STAY
|
Facility
|
IP
|
$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: Cash Price |
$10.45
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| 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: 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: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
IP
|
$22,736.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
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 PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
OP
|
$22,736.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| 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 |
$693.94
|
| 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 PERCUTANEOUS SHEATH INTRO 7FR
|
Facility
|
IP
|
$237.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901608009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$213.57 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Cash Price |
$130.52
|
| Rate for Payer: Central Health Plan Commercial |
$189.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.92
|
| Rate for Payer: EPIC Health Plan Senior |
$94.92
|
| Rate for Payer: Galaxy Health WC |
$201.71
|
| Rate for Payer: Global Benefits Group Commercial |
$142.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.46
|
| Rate for Payer: Multiplan Commercial |
$177.97
|
| Rate for Payer: Networks By Design Commercial |
$154.25
|
| Rate for Payer: Prime Health Services Commercial |
$201.71
|
|
|
HC PERCUTANEOUS SHEATH INTRO 7FR
|
Facility
|
OP
|
$237.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901608009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$213.57 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$114.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.37
|
| Rate for Payer: Blue Shield of California Commercial |
$144.99
|
| Rate for Payer: Blue Shield of California EPN |
$94.68
|
| Rate for Payer: Cash Price |
$130.52
|
| Rate for Payer: Central Health Plan Commercial |
$189.84
|
| Rate for Payer: Cigna of CA HMO |
$151.87
|
| Rate for Payer: Cigna of CA PPO |
$175.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.92
|
| Rate for Payer: EPIC Health Plan Senior |
$94.92
|
| Rate for Payer: Galaxy Health WC |
$201.71
|
| Rate for Payer: Global Benefits Group Commercial |
$142.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.57
|
| Rate for Payer: InnovAge PACE Commercial |
$118.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.11
|
| Rate for Payer: Multiplan Commercial |
$177.97
|
| Rate for Payer: Networks By Design Commercial |
$154.25
|
| Rate for Payer: Prime Health Services Commercial |
$201.71
|
| Rate for Payer: Riverside University Health System MISP |
$94.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.65
|
| Rate for Payer: United Healthcare All Other HMO |
$118.65
|
| Rate for Payer: United Healthcare HMO Rider |
$118.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.71
|
| Rate for Payer: Vantage Medical Group Senior |
$201.71
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
IP
|
$12,212.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,442.40 |
| Max. Negotiated Rate |
$10,990.80 |
| Rate for Payer: Adventist Health Commercial |
$2,442.40
|
| Rate for Payer: Cash Price |
$6,716.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,769.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,884.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,884.80
|
| Rate for Payer: Galaxy Health WC |
$10,380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,990.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,145.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,652.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,559.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,442.40
|
| Rate for Payer: Multiplan Commercial |
$9,159.00
|
| Rate for Payer: Networks By Design Commercial |
$7,937.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,380.20
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
OP
|
$12,212.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$2,442.40
|
| 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 |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| 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 |
$14,462.30
|
| Rate for Payer: Cash Price |
$6,716.60
|
| Rate for Payer: Cash Price |
$6,716.60
|
| Rate for Payer: Cash Price |
$6,716.60
|
| Rate for Payer: Cash Price |
$6,716.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,769.60
|
| Rate for Payer: Cigna of CA HMO |
$7,815.68
|
| Rate for Payer: Cigna of CA PPO |
$9,036.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$10,380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,990.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,145.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,442.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$9,159.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$7,937.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,380.20
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,327.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,106.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,106.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,106.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,106.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,021.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,261.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,020.97
|
| Rate for Payer: Blue Shield of California EPN |
$667.75
|
| Rate for Payer: Cash Price |
$925.10
|
| Rate for Payer: Cash Price |
$925.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,076.48
|
| Rate for Payer: Cigna of CA PPO |
$1,244.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,429.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,429.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.50
|
| Rate for Payer: InnovAge PACE Commercial |
$841.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: Riverside University Health System MISP |
$672.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$841.00
|
| Rate for Payer: United Healthcare All Other HMO |
$841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,429.70
|
|
|
HC PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Cash Price |
$925.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
IP
|
$28,097.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,619.40 |
| Max. Negotiated Rate |
$25,287.30 |
| Rate for Payer: Adventist Health Commercial |
$5,619.40
|
| Rate for Payer: Cash Price |
$15,453.35
|
| Rate for Payer: Central Health Plan Commercial |
$22,477.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,238.80
|
| Rate for Payer: Galaxy Health WC |
$23,882.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,858.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,287.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,740.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,704.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,392.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,619.40
|
| Rate for Payer: Multiplan Commercial |
$21,072.75
|
| Rate for Payer: Networks By Design Commercial |
$18,263.05
|
| Rate for Payer: Prime Health Services Commercial |
$23,882.45
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
OP
|
$28,097.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$436.09 |
| Max. Negotiated Rate |
$25,287.30 |
| Rate for Payer: Adventist Health Commercial |
$5,619.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$17,054.88
|
| Rate for Payer: Blue Shield of California EPN |
$11,154.51
|
| Rate for Payer: Cash Price |
$15,453.35
|
| Rate for Payer: Cash Price |
$15,453.35
|
| Rate for Payer: Cash Price |
$15,453.35
|
| Rate for Payer: Central Health Plan Commercial |
$22,477.60
|
| Rate for Payer: Cigna of CA HMO |
$17,982.08
|
| Rate for Payer: Cigna of CA PPO |
$20,791.78
|
| 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 |
$23,882.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,858.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,287.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$436.09
|
| 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 |
$18,740.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,619.40
|
| 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 |
$21,072.75
|
| Rate for Payer: Networks By Design Commercial |
$18,263.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$23,882.45
|
| 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 |
$16,858.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,858.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,048.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14,048.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14,048.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,048.50
|
| 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 PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
IP
|
$19,813.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,962.60 |
| Max. Negotiated Rate |
$17,831.70 |
| Rate for Payer: Adventist Health Commercial |
$3,962.60
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,850.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,925.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,925.20
|
| Rate for Payer: Galaxy Health WC |
$16,841.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,887.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,831.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,548.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,264.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,962.60
|
| Rate for Payer: Multiplan Commercial |
$14,859.75
|
| Rate for Payer: Networks By Design Commercial |
$12,878.45
|
| Rate for Payer: Prime Health Services Commercial |
$16,841.05
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
OP
|
$19,813.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.76 |
| Max. Negotiated Rate |
$17,831.70 |
| Rate for Payer: Adventist Health Commercial |
$3,962.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Cash Price |
$10,897.15
|
| Rate for Payer: Central Health Plan Commercial |
$15,850.40
|
| Rate for Payer: Cigna of CA HMO |
$12,680.32
|
| Rate for Payer: Cigna of CA PPO |
$14,661.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$16,841.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,887.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,831.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,962.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$14,859.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$12,878.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,841.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,887.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,906.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,906.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,906.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,906.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.60 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Adventist Health Commercial |
$148.60
|
| Rate for Payer: Cash Price |
$408.65
|
| Rate for Payer: Central Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.20
|
| Rate for Payer: EPIC Health Plan Senior |
$297.20
|
| Rate for Payer: Galaxy Health WC |
$631.55
|
| Rate for Payer: Global Benefits Group Commercial |
$445.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$668.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$495.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$459.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.60
|
| Rate for Payer: Multiplan Commercial |
$557.25
|
| Rate for Payer: Networks By Design Commercial |
$482.95
|
| Rate for Payer: Prime Health Services Commercial |
$631.55
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.60 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Adventist Health Commercial |
$148.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$451.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$631.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$408.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$557.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$359.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.36
|
| Rate for Payer: Blue Shield of California Commercial |
$451.00
|
| Rate for Payer: Blue Shield of California EPN |
$294.97
|
| Rate for Payer: Cash Price |
$408.65
|
| Rate for Payer: Central Health Plan Commercial |
$594.40
|
| Rate for Payer: Cigna of CA HMO |
$475.52
|
| Rate for Payer: Cigna of CA PPO |
$549.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$631.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$631.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$631.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.20
|
| Rate for Payer: EPIC Health Plan Senior |
$297.20
|
| Rate for Payer: Galaxy Health WC |
$631.55
|
| Rate for Payer: Global Benefits Group Commercial |
$445.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$668.70
|
| Rate for Payer: InnovAge PACE Commercial |
$371.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$495.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$459.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$520.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$520.10
|
| Rate for Payer: Multiplan Commercial |
$557.25
|
| Rate for Payer: Networks By Design Commercial |
$482.95
|
| Rate for Payer: Prime Health Services Commercial |
$631.55
|
| Rate for Payer: Riverside University Health System MISP |
$297.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$445.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$445.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$371.50
|
| Rate for Payer: United Healthcare All Other HMO |
$371.50
|
| Rate for Payer: United Healthcare HMO Rider |
$371.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$631.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$631.55
|
| Rate for Payer: Vantage Medical Group Senior |
$631.55
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$806.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: InnovAge PACE Commercial |
$664.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$643.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: InnovAge PACE Commercial |
$664.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$664.00
|
| Rate for Payer: United Healthcare All Other HMO |
$664.00
|
| Rate for Payer: United Healthcare HMO Rider |
$664.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$664.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$643.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: InnovAge PACE Commercial |
$664.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$929.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$664.00
|
| Rate for Payer: United Healthcare All Other HMO |
$664.00
|
| Rate for Payer: United Healthcare HMO Rider |
$664.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$664.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$885.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$822.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$206.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$498.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.92
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Central Health Plan Commercial |
$824.00
|
| Rate for Payer: Cigna of CA HMO |
$659.20
|
| Rate for Payer: Cigna of CA PPO |
$762.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$875.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.00
|
| Rate for Payer: EPIC Health Plan Senior |
$412.00
|
| Rate for Payer: Galaxy Health WC |
$875.50
|
| Rate for Payer: Global Benefits Group Commercial |
$618.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.00
|
| Rate for Payer: InnovAge PACE Commercial |
$515.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.00
|
| Rate for Payer: Multiplan Commercial |
$772.50
|
| Rate for Payer: Networks By Design Commercial |
$669.50
|
| Rate for Payer: Prime Health Services Commercial |
$875.50
|
| Rate for Payer: Riverside University Health System MISP |
$412.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$515.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$515.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.50
|
| Rate for Payer: Vantage Medical Group Senior |
$875.50
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Adventist Health Commercial |
$206.00
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Central Health Plan Commercial |
$824.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.00
|
| Rate for Payer: EPIC Health Plan Senior |
$412.00
|
| Rate for Payer: Galaxy Health WC |
$875.50
|
| Rate for Payer: Global Benefits Group Commercial |
$618.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Multiplan Commercial |
$772.50
|
| Rate for Payer: Networks By Design Commercial |
$669.50
|
| Rate for Payer: Prime Health Services Commercial |
$875.50
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Adventist Health Commercial |
$206.00
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Central Health Plan Commercial |
$824.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.00
|
| Rate for Payer: EPIC Health Plan Senior |
$412.00
|
| Rate for Payer: Galaxy Health WC |
$875.50
|
| Rate for Payer: Global Benefits Group Commercial |
$618.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Multiplan Commercial |
$772.50
|
| Rate for Payer: Networks By Design Commercial |
$669.50
|
| Rate for Payer: Prime Health Services Commercial |
$875.50
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Adventist Health Commercial |
$206.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$625.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Central Health Plan Commercial |
$824.00
|
| Rate for Payer: Cigna of CA HMO |
$659.20
|
| Rate for Payer: Cigna of CA PPO |
$762.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$875.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.00
|
| Rate for Payer: EPIC Health Plan Senior |
$412.00
|
| Rate for Payer: Galaxy Health WC |
$875.50
|
| Rate for Payer: Global Benefits Group Commercial |
$618.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$927.00
|
| Rate for Payer: InnovAge PACE Commercial |
$515.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$687.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$637.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.00
|
| Rate for Payer: Multiplan Commercial |
$772.50
|
| Rate for Payer: Networks By Design Commercial |
$669.50
|
| Rate for Payer: Prime Health Services Commercial |
$875.50
|
| Rate for Payer: Riverside University Health System MISP |
$412.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$618.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.50
|
| Rate for Payer: Vantage Medical Group Senior |
$875.50
|
|
