|
HC REP LEG TENDON PRIMARY EA
|
Facility
|
OP
|
$13,539.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$2,707.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$6,092.55
|
| Rate for Payer: Cash Price |
$6,092.55
|
| Rate for Payer: Cash Price |
$6,092.55
|
| Rate for Payer: Cash Price |
$6,092.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,831.20
|
| Rate for Payer: Cigna of CA HMO |
$8,664.96
|
| Rate for Payer: Cigna of CA PPO |
$10,018.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,477.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$11,508.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,123.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,185.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,597.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$462.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$10,154.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$8,800.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,508.15
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,123.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,769.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,769.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,769.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,769.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC REP LEG TENDON PRIMARY EA
|
Facility
|
IP
|
$13,539.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,707.80 |
| Max. Negotiated Rate |
$12,185.10 |
| Rate for Payer: Adventist Health Commercial |
$2,707.80
|
| Rate for Payer: Cash Price |
$6,092.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,831.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,477.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,415.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,415.60
|
| Rate for Payer: Galaxy Health WC |
$11,508.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,123.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,185.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,597.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,988.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.80
|
| Rate for Payer: Multiplan Commercial |
$10,154.25
|
| Rate for Payer: Networks By Design Commercial |
$8,800.35
|
| Rate for Payer: Prime Health Services Commercial |
$11,508.15
|
|
|
HC REP OF NAIL BED
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,621.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
|
|
HC REP OF NAIL BED
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,126.68
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$735.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Cigna of CA HMO |
$1,758.72
|
| Rate for Payer: Cigna of CA PPO |
$2,033.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,648.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,648.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP OF NAIL BED
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$2,473.20 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,099.20
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,621.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
|
|
HC REP OF NAIL BED
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$549.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Cash Price |
$1,236.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,198.40
|
| Rate for Payer: Cigna of CA HMO |
$1,758.72
|
| Rate for Payer: Cigna of CA PPO |
$2,033.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,923.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,335.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,473.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,744.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,061.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,786.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,335.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,374.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,374.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$535.60 |
| Max. Negotiated Rate |
$2,410.20 |
| Rate for Payer: Adventist Health Commercial |
$535.60
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,071.20
|
| Rate for Payer: Galaxy Health WC |
$2,276.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,580.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.60
|
| Rate for Payer: Multiplan Commercial |
$2,008.50
|
| Rate for Payer: Networks By Design Commercial |
$1,740.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.30
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$535.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$535.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,296.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,557.79
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.40
|
| Rate for Payer: Cigna of CA HMO |
$1,713.92
|
| Rate for Payer: Cigna of CA PPO |
$1,981.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$2,276.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,008.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,740.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.30
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,606.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.00
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$535.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.40
|
| Rate for Payer: Cigna of CA HMO |
$1,713.92
|
| Rate for Payer: Cigna of CA PPO |
$1,981.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$2,276.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$867.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,008.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,740.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.30
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,606.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,339.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$535.60 |
| Max. Negotiated Rate |
$2,410.20 |
| Rate for Payer: Adventist Health Commercial |
$535.60
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,874.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,071.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,071.20
|
| Rate for Payer: Galaxy Health WC |
$2,276.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,606.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,410.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,700.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,580.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.60
|
| Rate for Payer: Multiplan Commercial |
$2,008.50
|
| Rate for Payer: Networks By Design Commercial |
$1,740.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,276.30
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
IP
|
$5,681.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,136.20 |
| Max. Negotiated Rate |
$5,112.90 |
| Rate for Payer: Adventist Health Commercial |
$1,136.20
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,544.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,976.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,272.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,272.40
|
| Rate for Payer: Galaxy Health WC |
$4,828.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,112.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,607.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,351.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.20
|
| Rate for Payer: Multiplan Commercial |
$4,260.75
|
| Rate for Payer: Networks By Design Commercial |
$3,692.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,828.85
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
IP
|
$5,681.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,136.20 |
| Max. Negotiated Rate |
$5,112.90 |
| Rate for Payer: Adventist Health Commercial |
$1,136.20
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,544.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,976.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,272.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,272.40
|
| Rate for Payer: Galaxy Health WC |
$4,828.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,112.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,607.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,351.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.20
|
| Rate for Payer: Multiplan Commercial |
$4,260.75
|
| Rate for Payer: Networks By Design Commercial |
$3,692.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,828.85
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
OP
|
$5,681.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,136.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,544.80
|
| Rate for Payer: Cigna of CA HMO |
$3,692.65
|
| Rate for Payer: Cigna of CA PPO |
$4,203.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,976.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,828.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,112.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,607.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,260.75
|
| Rate for Payer: Networks By Design Commercial |
$3,692.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Prime Health Services Commercial |
$4,828.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,408.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,408.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,840.50
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
OP
|
$5,681.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,136.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,024.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Cash Price |
$2,556.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,544.80
|
| Rate for Payer: Cigna of CA HMO |
$3,635.84
|
| Rate for Payer: Cigna of CA PPO |
$4,203.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,976.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,828.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,408.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,112.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,607.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,260.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,692.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,828.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,146.11
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,227.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,408.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,840.50
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$6,134.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,226.80 |
| Max. Negotiated Rate |
$5,520.60 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,907.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,293.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,453.60
|
| Rate for Payer: Galaxy Health WC |
$5,213.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,520.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,895.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,619.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.80
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
| Rate for Payer: Networks By Design Commercial |
$3,987.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,213.90
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$6,134.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,373.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,600.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,579.41
|
| Rate for Payer: Blue Shield of California EPN |
$6,020.76
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,907.20
|
| Rate for Payer: Cigna of CA HMO |
$3,987.10
|
| Rate for Payer: Cigna of CA PPO |
$4,539.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,213.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,213.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,293.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,453.60
|
| Rate for Payer: Galaxy Health WC |
$5,213.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,680.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,520.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,895.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,619.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,293.80
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
| Rate for Payer: Networks By Design Commercial |
$3,987.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,213.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,453.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,680.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,680.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,067.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,213.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,213.90
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
IP
|
$21,303.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,260.60 |
| Max. Negotiated Rate |
$19,172.70 |
| Rate for Payer: Adventist Health Commercial |
$4,260.60
|
| Rate for Payer: Cash Price |
$9,586.35
|
| Rate for Payer: Central Health Plan Commercial |
$17,042.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,912.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,521.20
|
| Rate for Payer: Galaxy Health WC |
$18,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$12,781.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,172.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,527.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,568.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,260.60
|
| Rate for Payer: Multiplan Commercial |
$15,977.25
|
| Rate for Payer: Networks By Design Commercial |
$13,846.95
|
| Rate for Payer: Prime Health Services Commercial |
$18,107.55
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
OP
|
$21,303.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$19,172.70 |
| Rate for Payer: Adventist Health Commercial |
$4,260.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$9,586.35
|
| Rate for Payer: Cash Price |
$9,586.35
|
| Rate for Payer: Cash Price |
$9,586.35
|
| Rate for Payer: Cash Price |
$9,586.35
|
| Rate for Payer: Central Health Plan Commercial |
$17,042.40
|
| Rate for Payer: Cigna of CA HMO |
$13,633.92
|
| Rate for Payer: Cigna of CA PPO |
$15,764.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,912.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$18,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$12,781.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,172.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,527.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$881.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,260.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$15,977.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$13,846.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,107.55
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,781.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,651.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10,651.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10,651.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,651.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
IP
|
$8,782.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,756.40 |
| Max. Negotiated Rate |
$7,903.80 |
| Rate for Payer: Adventist Health Commercial |
$1,756.40
|
| Rate for Payer: Cash Price |
$3,951.90
|
| Rate for Payer: Central Health Plan Commercial |
$7,025.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,147.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,512.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,512.80
|
| Rate for Payer: Galaxy Health WC |
$7,464.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,903.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,576.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,181.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,756.40
|
| Rate for Payer: Multiplan Commercial |
$6,586.50
|
| Rate for Payer: Networks By Design Commercial |
$5,708.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,464.70
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
OP
|
$8,782.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,903.80 |
| Rate for Payer: Adventist Health Commercial |
$1,756.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$3,951.90
|
| Rate for Payer: Cash Price |
$3,951.90
|
| Rate for Payer: Cash Price |
$3,951.90
|
| Rate for Payer: Cash Price |
$3,951.90
|
| Rate for Payer: Central Health Plan Commercial |
$7,025.60
|
| Rate for Payer: Cigna of CA HMO |
$5,620.48
|
| Rate for Payer: Cigna of CA PPO |
$6,498.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,147.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$7,464.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,269.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,903.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,576.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,768.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,756.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$6,586.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$5,708.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$7,464.70
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,269.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,391.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,391.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,391.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
OP
|
$4,986.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,988.80
|
| Rate for Payer: Cigna of CA HMO |
$3,191.04
|
| Rate for Payer: Cigna of CA PPO |
$3,689.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,490.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$4,238.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,991.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,487.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,166.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$713.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,739.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,240.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$4,238.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,991.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,493.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,493.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,493.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
IP
|
$4,986.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$4,487.40 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,988.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,490.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,994.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,994.40
|
| Rate for Payer: Galaxy Health WC |
$4,238.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,991.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,487.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,166.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,941.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.20
|
| Rate for Payer: Multiplan Commercial |
$3,739.50
|
| Rate for Payer: Networks By Design Commercial |
$3,240.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,238.10
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$601.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$607.16
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: Cigna of CA HMO |
$938.24
|
| Rate for Payer: Cigna of CA PPO |
$1,084.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,026.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.53
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$930.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.34
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Multiplan WC |
$607.16
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.03
|
| Rate for Payer: Preferred Health Network WC |
$619.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
| Rate for Payer: Prime Health Services Medicare |
$418.73
|
| Rate for Payer: Prime Health Services WC |
$600.96
|
| Rate for Payer: Riverside University Health System MISP |
$434.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$879.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Vantage Medical Group Senior |
$395.03
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,319.40 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,026.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Senior |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$930.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$864.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,319.40 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,026.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Senior |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$930.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$864.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
