|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
|
IP
|
$6,845.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,369.00 |
| Max. Negotiated Rate |
$6,160.50 |
| Rate for Payer: Cash Price |
$3,080.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,738.00
|
| Rate for Payer: Galaxy Health WC |
$5,818.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,107.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,160.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,565.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,607.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.00
|
| Rate for Payer: Multiplan Commercial |
$5,133.75
|
| Rate for Payer: Networks By Design Commercial |
$4,449.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,818.25
|
|
|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
|
OP
|
$6,845.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$4,107.00
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$3,080.25
|
| Rate for Payer: Cash Price |
$3,080.25
|
| Rate for Payer: Cash Price |
$3,080.25
|
| Rate for Payer: Cash Price |
$3,080.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,476.00
|
| Rate for Payer: Cigna of CA PPO |
$5,065.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$5,818.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,107.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,160.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,133.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,565.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$5,133.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$4,449.25
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$5,818.25
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,107.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,422.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,422.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,422.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,422.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
OP
|
$17,052.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,075.64 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,231.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$7,673.40
|
| Rate for Payer: Cash Price |
$7,673.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,641.60
|
| Rate for Payer: Cigna of CA PPO |
$12,618.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$14,494.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,346.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,789.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,783.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,075.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$12,789.00
|
| Rate for Payer: Networks By Design Commercial |
$11,083.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,494.20
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Riverside University Health System MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,231.20
|
| 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 Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
IP
|
$17,052.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,410.40 |
| Max. Negotiated Rate |
$15,346.80 |
| Rate for Payer: Cash Price |
$7,673.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,820.80
|
| Rate for Payer: Galaxy Health WC |
$14,494.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,346.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,496.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.40
|
| Rate for Payer: Multiplan Commercial |
$12,789.00
|
| Rate for Payer: Networks By Design Commercial |
$11,083.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,494.20
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
IP
|
$6,072.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,214.40 |
| Max. Negotiated Rate |
$5,464.80 |
| Rate for Payer: Cash Price |
$2,732.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,428.80
|
| Rate for Payer: Galaxy Health WC |
$5,161.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,643.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,464.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,050.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,313.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.40
|
| Rate for Payer: Multiplan Commercial |
$4,554.00
|
| Rate for Payer: Networks By Design Commercial |
$3,946.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,161.20
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
OP
|
$6,072.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,214.40 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,643.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$2,732.40
|
| Rate for Payer: Cash Price |
$2,732.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,857.60
|
| Rate for Payer: Cigna of CA PPO |
$4,493.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$5,161.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,643.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,464.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,554.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,050.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,078.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$4,554.00
|
| Rate for Payer: Networks By Design Commercial |
$3,946.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,161.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,643.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
IP
|
$7,730.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,546.00 |
| Max. Negotiated Rate |
$6,957.00 |
| Rate for Payer: Cash Price |
$3,478.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.00
|
| Rate for Payer: Galaxy Health WC |
$6,570.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.00
|
| Rate for Payer: Multiplan Commercial |
$5,797.50
|
| Rate for Payer: Networks By Design Commercial |
$5,024.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,570.50
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
OP
|
$7,730.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$6,957.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$862.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,198.96
|
| Rate for Payer: Blue Distinction Transplant |
$4,638.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,777.14
|
| Rate for Payer: Blue Shield of California EPN |
$3,756.78
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$3,478.50
|
| Rate for Payer: Cash Price |
$3,478.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,184.00
|
| Rate for Payer: Cigna of CA HMO |
$4,947.20
|
| Rate for Payer: Cigna of CA PPO |
$5,720.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$6,570.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,957.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,797.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$5,797.50
|
| Rate for Payer: Networks By Design Commercial |
$5,024.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,570.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
OP
|
$3,554.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$710.80 |
| Max. Negotiated Rate |
$6,571.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$875.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,198.96
|
| Rate for Payer: Blue Distinction Transplant |
$2,132.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,196.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,727.24
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$1,599.30
|
| Rate for Payer: Cash Price |
$1,599.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,843.20
|
| Rate for Payer: Cigna of CA HMO |
$2,274.56
|
| Rate for Payer: Cigna of CA PPO |
$2,629.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$3,020.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,132.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,198.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,665.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,370.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$2,665.50
|
| Rate for Payer: Networks By Design Commercial |
$2,310.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,132.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,132.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
IP
|
$3,554.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$710.80 |
| Max. Negotiated Rate |
$3,198.60 |
| Rate for Payer: Cash Price |
$1,599.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,843.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,421.60
|
| Rate for Payer: Galaxy Health WC |
$3,020.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,132.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,198.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,370.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,354.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.80
|
| Rate for Payer: Multiplan Commercial |
$2,665.50
|
| Rate for Payer: Networks By Design Commercial |
$2,310.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.90
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
IP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,317.80 |
| Max. Negotiated Rate |
$23,930.10 |
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Central Health Plan Commercial |
$21,271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,635.60
|
| Rate for Payer: Galaxy Health WC |
$22,600.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,953.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,930.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,734.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,130.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,317.80
|
| Rate for Payer: Multiplan Commercial |
$19,941.75
|
| Rate for Payer: Networks By Design Commercial |
$17,282.85
|
| Rate for Payer: Prime Health Services Commercial |
$22,600.65
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
OP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.09 |
| Max. Negotiated Rate |
$23,930.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,162.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,600.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,623.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,623.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,953.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Central Health Plan Commercial |
$21,271.20
|
| Rate for Payer: Cigna of CA PPO |
$19,675.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,600.65
|
| Rate for Payer: Dignity Health Media |
$22,600.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,600.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,635.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,635.60
|
| Rate for Payer: Galaxy Health WC |
$22,600.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,953.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,930.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19,941.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,306.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,734.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,317.80
|
| Rate for Payer: Multiplan Commercial |
$19,941.75
|
| Rate for Payer: Networks By Design Commercial |
$17,282.85
|
| Rate for Payer: Prime Health Services Commercial |
$22,600.65
|
| Rate for Payer: Riverside University Health System MISP |
$10,635.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,953.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,600.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22,600.65
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
IP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,317.80 |
| Max. Negotiated Rate |
$23,930.10 |
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Central Health Plan Commercial |
$21,271.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,635.60
|
| Rate for Payer: Galaxy Health WC |
$22,600.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,953.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,930.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,734.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,130.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,317.80
|
| Rate for Payer: Multiplan Commercial |
$19,941.75
|
| Rate for Payer: Networks By Design Commercial |
$17,282.85
|
| Rate for Payer: Prime Health Services Commercial |
$22,600.65
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
OP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.09 |
| Max. Negotiated Rate |
$23,930.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,162.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,600.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,623.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,623.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,953.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Central Health Plan Commercial |
$21,271.20
|
| Rate for Payer: Cigna of CA PPO |
$19,675.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,600.65
|
| Rate for Payer: Dignity Health Media |
$22,600.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,600.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,635.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,635.60
|
| Rate for Payer: Galaxy Health WC |
$22,600.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,953.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,930.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19,941.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,306.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,734.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,317.80
|
| Rate for Payer: Multiplan Commercial |
$19,941.75
|
| Rate for Payer: Networks By Design Commercial |
$17,282.85
|
| Rate for Payer: Prime Health Services Commercial |
$22,600.65
|
| Rate for Payer: Riverside University Health System MISP |
$10,635.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,953.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,600.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22,600.65
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$14,328.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$12,895.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,701.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,880.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,880.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,937.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,464.98
|
| Rate for Payer: Blue Distinction Transplant |
$8,596.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,462.40
|
| Rate for Payer: Cigna of CA PPO |
$10,602.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Dignity Health Media |
$12,178.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,178.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,731.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,731.20
|
| Rate for Payer: Galaxy Health WC |
$12,178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,596.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,895.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,746.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,014.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,458.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.60
|
| Rate for Payer: Multiplan Commercial |
$10,746.00
|
| Rate for Payer: Networks By Design Commercial |
$9,313.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,178.80
|
| Rate for Payer: Riverside University Health System MISP |
$5,731.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,596.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,178.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,178.80
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$14,328.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,865.60 |
| Max. Negotiated Rate |
$12,895.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,880.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,880.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,937.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,464.98
|
| Rate for Payer: Blue Distinction Transplant |
$8,596.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,462.40
|
| Rate for Payer: Cigna of CA PPO |
$10,602.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Dignity Health Media |
$12,178.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,178.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,731.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,731.20
|
| Rate for Payer: Galaxy Health WC |
$12,178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,596.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,895.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,746.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,014.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,556.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.60
|
| Rate for Payer: Multiplan Commercial |
$10,746.00
|
| Rate for Payer: Networks By Design Commercial |
$9,313.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,178.80
|
| Rate for Payer: Riverside University Health System MISP |
$5,731.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,596.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,164.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,164.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,164.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,164.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,178.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,178.80
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$14,328.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,865.60 |
| Max. Negotiated Rate |
$12,895.20 |
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,462.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,731.20
|
| Rate for Payer: Galaxy Health WC |
$12,178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,596.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,895.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,458.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.60
|
| Rate for Payer: Multiplan Commercial |
$10,746.00
|
| Rate for Payer: Networks By Design Commercial |
$9,313.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,178.80
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$14,328.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,865.60 |
| Max. Negotiated Rate |
$12,895.20 |
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,462.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,731.20
|
| Rate for Payer: Galaxy Health WC |
$12,178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,596.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,895.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,458.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.60
|
| Rate for Payer: Multiplan Commercial |
$10,746.00
|
| Rate for Payer: Networks By Design Commercial |
$9,313.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,178.80
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
OP
|
$17,191.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.04 |
| Max. Negotiated Rate |
$15,471.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,314.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Central Health Plan Commercial |
$13,752.80
|
| Rate for Payer: Cigna of CA PPO |
$12,721.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$14,612.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,314.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,471.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,893.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,466.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,438.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$12,893.25
|
| Rate for Payer: Networks By Design Commercial |
$11,174.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,612.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,314.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,595.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,595.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,595.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,595.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
IP
|
$17,191.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,438.20 |
| Max. Negotiated Rate |
$15,471.90 |
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Central Health Plan Commercial |
$13,752.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,876.40
|
| Rate for Payer: Galaxy Health WC |
$14,612.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,314.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,471.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,466.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,549.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,438.20
|
| Rate for Payer: Multiplan Commercial |
$12,893.25
|
| Rate for Payer: Networks By Design Commercial |
$11,174.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,612.35
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Blue Shield of California EPN |
$140.44
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.31
|
| Rate for Payer: United Healthcare All Other HMO |
$96.99
|
| Rate for Payer: United Healthcare HMO Rider |
$94.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.49
|
| Rate for Payer: Blue Distinction Transplant |
$157.80
|
| Rate for Payer: Blue Shield of California Commercial |
$197.25
|
| Rate for Payer: Blue Shield of California EPN |
$143.07
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Media |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$197.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Riverside University Health System MISP |
$105.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.50
|
| Rate for Payer: United Healthcare All Other HMO |
$131.50
|
| Rate for Payer: United Healthcare HMO Rider |
$131.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
OP
|
$1,532.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.40 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$930.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$741.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$905.11
|
| Rate for Payer: Blue Distinction Transplant |
$919.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,225.60
|
| Rate for Payer: Cigna of CA PPO |
$1,133.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,302.20
|
| Rate for Payer: Global Benefits Group Commercial |
$919.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,378.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,149.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,149.00
|
| Rate for Payer: Networks By Design Commercial |
$995.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,302.20
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$919.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
IP
|
$1,532.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.40 |
| Max. Negotiated Rate |
$1,378.80 |
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,225.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.80
|
| Rate for Payer: Galaxy Health WC |
$1,302.20
|
| Rate for Payer: Global Benefits Group Commercial |
$919.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,378.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$583.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$1,149.00
|
| Rate for Payer: Networks By Design Commercial |
$995.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,302.20
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
IP
|
$16,136.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,227.20 |
| Max. Negotiated Rate |
$14,522.40 |
| Rate for Payer: Cash Price |
$7,261.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,908.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,454.40
|
| Rate for Payer: Galaxy Health WC |
$13,715.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,522.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,762.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,147.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,227.20
|
| Rate for Payer: Multiplan Commercial |
$12,102.00
|
| Rate for Payer: Networks By Design Commercial |
$10,488.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,715.60
|
|
