|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
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
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
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 W/IMAGING
|
Facility
|
OP
|
$4,059.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.15 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$811.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,232.45
|
| Rate for Payer: Cash Price |
$2,232.45
|
| Rate for Payer: Cash Price |
$2,232.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,247.20
|
| Rate for Payer: Cigna of CA HMO |
$2,597.76
|
| Rate for Payer: Cigna of CA PPO |
$3,003.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,450.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,435.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,653.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,707.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$811.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,044.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,638.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,450.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,435.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$4,775.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$4,297.50 |
| Rate for Payer: Adventist Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,910.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,910.00
|
| Rate for Payer: Galaxy Health WC |
$4,058.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,865.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,297.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,184.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,819.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,955.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$955.00
|
| Rate for Payer: Multiplan Commercial |
$3,581.25
|
| Rate for Payer: Networks By Design Commercial |
$3,103.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,058.75
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$4,059.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$811.80 |
| Max. Negotiated Rate |
$3,653.10 |
| Rate for Payer: Adventist Health Commercial |
$811.80
|
| Rate for Payer: Cash Price |
$2,232.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,247.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,623.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,623.60
|
| Rate for Payer: Galaxy Health WC |
$3,450.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,435.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,653.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,707.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,546.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,512.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$811.80
|
| Rate for Payer: Multiplan Commercial |
$3,044.25
|
| Rate for Payer: Networks By Design Commercial |
$2,638.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,450.15
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$4,775.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.15 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$955.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,820.00
|
| Rate for Payer: Cigna of CA HMO |
$3,056.00
|
| Rate for Payer: Cigna of CA PPO |
$3,533.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,058.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,865.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,297.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,184.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$955.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,581.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,103.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,058.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,865.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$82.55
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$82.55
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC PERI PX DEV EVAL PROG 1/DUAL/MLT LEAD IMPL DFIB
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 93287
|
| Hospital Charge Code |
900200307
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.94
|
| 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 |
$37.40
|
| Rate for Payer: Cash Price |
$37.40
|
| Rate for Payer: Cash Price |
$37.40
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: InnovAge PACE Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.60
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Riverside University Health System MISP |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
HC PERI PX DEV EVAL PROG 1/DUAL/MLT LEAD IMPL DFIB
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 93287
|
| Hospital Charge Code |
900200307
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$37.40
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$559.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$493.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$318.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.44
|
| 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 |
$361.90
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Central Health Plan Commercial |
$526.40
|
| Rate for Payer: Cigna of CA HMO |
$421.12
|
| Rate for Payer: Cigna of CA PPO |
$486.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$559.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$559.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$559.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.20
|
| Rate for Payer: EPIC Health Plan Senior |
$263.20
|
| Rate for Payer: Galaxy Health WC |
$559.30
|
| Rate for Payer: Global Benefits Group Commercial |
$394.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$592.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.36
|
| Rate for Payer: InnovAge PACE Commercial |
$329.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$460.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$460.60
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
| Rate for Payer: Networks By Design Commercial |
$427.70
|
| Rate for Payer: Prime Health Services Commercial |
$559.30
|
| Rate for Payer: Riverside University Health System MISP |
$263.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$559.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$559.30
|
| Rate for Payer: Vantage Medical Group Senior |
$559.30
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$592.20 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Central Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.20
|
| Rate for Payer: EPIC Health Plan Senior |
$263.20
|
| Rate for Payer: Galaxy Health WC |
$559.30
|
| Rate for Payer: Global Benefits Group Commercial |
$394.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$592.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.60
|
| Rate for Payer: Multiplan Commercial |
$493.50
|
| Rate for Payer: Networks By Design Commercial |
$427.70
|
| Rate for Payer: Prime Health Services Commercial |
$559.30
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$1,142.54 |
| Rate for Payer: Adventist Health Commercial |
$235.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$696.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$714.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.75
|
| Rate for Payer: Blue Shield of California Commercial |
$714.44
|
| Rate for Payer: Blue Shield of California EPN |
$467.27
|
| Rate for Payer: Cash Price |
$647.35
|
| Rate for Payer: Cash Price |
$647.35
|
| Rate for Payer: Central Health Plan Commercial |
$941.60
|
| Rate for Payer: Cigna of CA HMO |
$753.28
|
| Rate for Payer: Cigna of CA PPO |
$870.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$1,000.45
|
| Rate for Payer: Global Benefits Group Commercial |
$706.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,059.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$933.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Networks By Design Commercial |
$765.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$696.67
|
| Rate for Payer: Prime Health Services Commercial |
$1,000.45
|
| Rate for Payer: Prime Health Services Medicare |
$738.47
|
| Rate for Payer: Riverside University Health System MISP |
$766.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.40 |
| Max. Negotiated Rate |
$1,059.30 |
| Rate for Payer: Adventist Health Commercial |
$235.40
|
| Rate for Payer: Cash Price |
$647.35
|
| Rate for Payer: Central Health Plan Commercial |
$941.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$470.80
|
| Rate for Payer: EPIC Health Plan Senior |
$470.80
|
| Rate for Payer: Galaxy Health WC |
$1,000.45
|
| Rate for Payer: Global Benefits Group Commercial |
$706.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,059.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$728.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.40
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Networks By Design Commercial |
$765.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,000.45
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Blue Shield of California Commercial |
$862.67
|
| Rate for Payer: Blue Shield of California EPN |
$562.46
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$690.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$558.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.83
|
| Rate for Payer: United Healthcare All Other HMO |
$407.67
|
| Rate for Payer: United Healthcare HMO Rider |
$398.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$365.49
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$613.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$837.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$509.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.93
|
| Rate for Payer: Blue Shield of California Commercial |
$862.67
|
| Rate for Payer: Blue Shield of California EPN |
$562.46
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$948.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$948.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$948.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: InnovAge PACE Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$690.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$781.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$781.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$558.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Riverside University Health System MISP |
$446.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.83
|
| Rate for Payer: United Healthcare All Other HMO |
$407.67
|
| Rate for Payer: United Healthcare HMO Rider |
$398.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$365.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$948.60
|
| Rate for Payer: Vantage Medical Group Senior |
$948.60
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
915350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.65
|
| Rate for Payer: Blue Shield of California Commercial |
$45.61
|
| Rate for Payer: Blue Shield of California EPN |
$29.74
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.30
|
| Rate for Payer: InnovAge PACE Commercial |
$29.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Riverside University Health System MISP |
$23.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50.15
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.65
|
| Rate for Payer: Blue Shield of California Commercial |
$45.61
|
| Rate for Payer: Blue Shield of California EPN |
$29.74
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.30
|
| Rate for Payer: InnovAge PACE Commercial |
$29.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Riverside University Health System MISP |
$23.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50.15
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
915350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.61
|
| Rate for Payer: Blue Shield of California EPN |
$29.74
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$45.61
|
| Rate for Payer: Blue Shield of California EPN |
$29.74
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$776.00 |
| Max. Negotiated Rate |
$3,492.00 |
| Rate for Payer: Adventist Health Commercial |
$776.00
|
| Rate for Payer: Cash Price |
$2,134.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.00
|
| Rate for Payer: Galaxy Health WC |
$3,298.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,587.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,401.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.00
|
| Rate for Payer: Multiplan Commercial |
$2,910.00
|
| Rate for Payer: Networks By Design Commercial |
$2,522.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.00
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$776.00 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$776.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,134.00
|
| Rate for Payer: Cash Price |
$2,134.00
|
| Rate for Payer: Cash Price |
$2,134.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,104.00
|
| Rate for Payer: Cigna of CA HMO |
$2,483.20
|
| Rate for Payer: Cigna of CA PPO |
$2,871.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$3,298.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,492.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,587.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$2,910.00
|
| Rate for Payer: Networks By Design Commercial |
$2,522.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,037.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$232.48
|
| Rate for Payer: Blue Shield of California EPN |
$152.05
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Cash Price |
$210.65
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1,556.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,390.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,100.23
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| 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: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
