|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$23,494.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,698.80 |
| Max. Negotiated Rate |
$21,144.60 |
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Central Health Plan Commercial |
$18,795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,397.60
|
| Rate for Payer: Galaxy Health WC |
$19,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,096.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,144.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,951.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,698.80
|
| Rate for Payer: Multiplan Commercial |
$17,620.50
|
| Rate for Payer: Networks By Design Commercial |
$15,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,969.90
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$23,494.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,028.24 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,715.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,921.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,921.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$14,096.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Central Health Plan Commercial |
$18,795.20
|
| Rate for Payer: Cigna of CA PPO |
$17,385.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Dignity Health Media |
$19,969.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,969.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,397.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,397.60
|
| Rate for Payer: Galaxy Health WC |
$19,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,096.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,144.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17,620.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,222.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,698.80
|
| Rate for Payer: Multiplan Commercial |
$17,620.50
|
| Rate for Payer: Networks By Design Commercial |
$15,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,969.90
|
| Rate for Payer: Riverside University Health System MISP |
$9,397.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,096.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,096.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,969.90
|
| Rate for Payer: Vantage Medical Group Senior |
$19,969.90
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$23,494.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,028.24 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,715.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,921.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,921.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$14,096.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Central Health Plan Commercial |
$18,795.20
|
| Rate for Payer: Cigna of CA PPO |
$17,385.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Dignity Health Media |
$19,969.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,969.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,397.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,397.60
|
| Rate for Payer: Galaxy Health WC |
$19,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,096.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,144.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17,620.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,222.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,698.80
|
| Rate for Payer: Multiplan Commercial |
$17,620.50
|
| Rate for Payer: Networks By Design Commercial |
$15,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,969.90
|
| Rate for Payer: Riverside University Health System MISP |
$9,397.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,096.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,096.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,969.90
|
| Rate for Payer: Vantage Medical Group Senior |
$19,969.90
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,025.80 |
| Max. Negotiated Rate |
$31,616.10 |
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Central Health Plan Commercial |
$28,103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.60
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,616.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,025.80
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,025.80 |
| Max. Negotiated Rate |
$31,616.10 |
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Central Health Plan Commercial |
$28,103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.60
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,616.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,025.80
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$31,616.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21,333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$21,077.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Central Health Plan Commercial |
$28,103.20
|
| Rate for Payer: Cigna of CA HMO |
$22,482.56
|
| Rate for Payer: Cigna of CA PPO |
$25,995.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,616.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26,346.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,679.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: InnovAge PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,025.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Riverside University Health System MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,077.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,077.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$31,616.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,745.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21,333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$21,077.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$13,745.22
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Central Health Plan Commercial |
$28,103.20
|
| Rate for Payer: Cigna of CA HMO |
$22,482.56
|
| Rate for Payer: Cigna of CA PPO |
$25,995.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,616.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26,346.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,679.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: InnovAge PACE Commercial |
$20,617.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,025.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,418.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
| Rate for Payer: Prime Health Services Medicare |
$14,569.93
|
| Rate for Payer: Riverside University Health System MISP |
$15,119.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,077.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,077.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PDL TUBE
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.07
|
| Rate for Payer: Blue Distinction Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$132.09
|
| Rate for Payer: Blue Shield of California EPN |
$102.69
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Media |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PDL TUBE
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
OP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
905357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,388.00 |
| Max. Negotiated Rate |
$8,712.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,324.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,324.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,687.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,718.94
|
| Rate for Payer: Blue Distinction Transplant |
$5,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,260.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,265.92
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,744.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,228.00
|
| Rate for Payer: Dignity Health Media |
$8,228.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,228.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,872.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,872.00
|
| Rate for Payer: Galaxy Health WC |
$8,228.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,808.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,712.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,260.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,388.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,354.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,968.80
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,872.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,808.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,808.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,840.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,840.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,840.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,840.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,228.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,228.00
|
|
|
HC PEDIATRIC ELECTRIC HAND
|
Facility
|
IP
|
$9,680.00
|
|
|
Service Code
|
CPT L7008
|
| Hospital Charge Code |
905357008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,936.00 |
| Max. Negotiated Rate |
$8,712.00 |
| Rate for Payer: Blue Shield of California EPN |
$5,169.12
|
| Rate for Payer: Cash Price |
$4,356.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,744.00
|
| Rate for Payer: Cigna of CA HMO |
$6,776.00
|
| Rate for Payer: Cigna of CA PPO |
$6,776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,872.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,872.00
|
| Rate for Payer: Galaxy Health WC |
$8,228.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,808.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,712.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,456.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,688.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,936.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$4,840.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,655.17
|
| Rate for Payer: United Healthcare All Other HMO |
$3,569.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3,492.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,194.40
|
|
|
HC PEDS PORT ACCESS KIT
|
Facility
|
OP
|
$4.10
|
|
| Hospital Charge Code |
901698559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.42
|
| Rate for Payer: Blue Distinction Transplant |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Media |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC PEDS PORT ACCESS KIT
|
Facility
|
IP
|
$4.10
|
|
| Hospital Charge Code |
901698559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC PEDS URINE COLLCT CATH KIT 8FR
|
Facility
|
IP
|
$15.01
|
|
| Hospital Charge Code |
901698586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
|
|
HC PEDS URINE COLLCT CATH KIT 8FR
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
901698586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Distinction Transplant |
$9.01
|
| Rate for Payer: Blue Shield of California Commercial |
$9.44
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| Rate for Payer: Cigna of CA HMO |
$9.61
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.76
|
| Rate for Payer: Dignity Health Media |
$12.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
| Rate for Payer: Riverside University Health System MISP |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.34
|
| Rate for Payer: Blue Distinction Transplant |
$147.60
|
| Rate for Payer: Blue Shield of California Commercial |
$154.73
|
| Rate for Payer: Blue Shield of California EPN |
$120.29
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Media |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$184.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$208.20 |
| Max. Negotiated Rate |
$936.90 |
| Rate for Payer: Cash Price |
$468.45
|
| Rate for Payer: Central Health Plan Commercial |
$832.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.40
|
| Rate for Payer: Galaxy Health WC |
$884.85
|
| Rate for Payer: Global Benefits Group Commercial |
$624.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$694.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.20
|
| Rate for Payer: Multiplan Commercial |
$780.75
|
| Rate for Payer: Networks By Design Commercial |
$676.65
|
| Rate for Payer: Prime Health Services Commercial |
$884.85
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$936.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$219.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.02
|
| Rate for Payer: Blue Distinction Transplant |
$624.60
|
| Rate for Payer: Blue Shield of California Commercial |
$643.34
|
| Rate for Payer: Blue Shield of California EPN |
$505.93
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$468.45
|
| Rate for Payer: Cash Price |
$468.45
|
| Rate for Payer: Central Health Plan Commercial |
$832.80
|
| Rate for Payer: Cigna of CA HMO |
$666.24
|
| Rate for Payer: Cigna of CA PPO |
$770.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$884.85
|
| Rate for Payer: Global Benefits Group Commercial |
$624.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$780.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$694.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$780.75
|
| Rate for Payer: Networks By Design Commercial |
$676.65
|
| Rate for Payer: Prime Health Services Commercial |
$884.85
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$315.27 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$725.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$638.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.27
|
| Rate for Payer: Blue Distinction Transplant |
$791.40
|
| Rate for Payer: Blue Shield of California Commercial |
$989.25
|
| Rate for Payer: Blue Shield of California EPN |
$717.54
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Media |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$989.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$461.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.79
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Riverside University Health System MISP |
$527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.50
|
| Rate for Payer: United Healthcare All Other HMO |
$659.50
|
| Rate for Payer: United Healthcare HMO Rider |
$659.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$659.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Blue Shield of California EPN |
$704.35
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.05
|
| Rate for Payer: United Healthcare All Other HMO |
$486.45
|
| Rate for Payer: United Healthcare HMO Rider |
$475.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$435.27
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$221.73 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$385.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$470.28
|
| Rate for Payer: Blue Distinction Transplant |
$477.60
|
| Rate for Payer: Blue Shield of California Commercial |
$597.00
|
| Rate for Payer: Blue Shield of California EPN |
$433.02
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Media |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$597.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$278.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.36
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Riverside University Health System MISP |
$318.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$398.00
|
| Rate for Payer: United Healthcare All Other HMO |
$398.00
|
| Rate for Payer: United Healthcare HMO Rider |
$398.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$398.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Blue Shield of California EPN |
$425.06
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$300.57
|
| Rate for Payer: United Healthcare All Other HMO |
$293.56
|
| Rate for Payer: United Healthcare HMO Rider |
$287.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.68
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$7,849.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$7,064.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,709.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,937.02
|
| Rate for Payer: Blue Shield of California EPN |
$3,838.16
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,279.20
|
| Rate for Payer: Cigna of CA HMO |
$5,023.36
|
| Rate for Payer: Cigna of CA PPO |
$5,808.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,671.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,709.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,064.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,886.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,886.75
|
| Rate for Payer: Networks By Design Commercial |
$5,101.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,671.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,709.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,709.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,924.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,924.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,924.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,924.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$7,849.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$7,064.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,709.40
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,279.20
|
| Rate for Payer: Cigna of CA PPO |
$5,808.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,671.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,709.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,064.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,886.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,886.75
|
| Rate for Payer: Networks By Design Commercial |
$5,101.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,671.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,709.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,924.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,924.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,924.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,924.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
