|
HC PERITONEOGRAM
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.61 |
| Max. Negotiated Rate |
$1,292.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,292.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$269.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.05
|
| Rate for Payer: Blue Distinction Transplant |
$706.20
|
| Rate for Payer: Blue Shield of California Commercial |
$727.39
|
| Rate for Payer: Blue Shield of California EPN |
$572.02
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$941.60
|
| Rate for Payer: Cigna of CA HMO |
$753.28
|
| Rate for Payer: Cigna of CA PPO |
$870.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,000.45
|
| Rate for Payer: Global Benefits Group Commercial |
$706.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,059.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$882.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,137.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: InnovAge PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$785.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Networks By Design Commercial |
$765.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,000.45
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Riverside University Health System MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$706.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$706.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.35
|
| 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 |
$298.20
|
| 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 |
$223.65
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Central Health Plan Commercial |
$397.60
|
| Rate for Payer: Cigna of CA PPO |
$367.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.45
|
| Rate for Payer: Dignity Health Media |
$422.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$422.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$422.45
|
| Rate for Payer: Global Benefits Group Commercial |
$298.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$447.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$372.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$331.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$372.75
|
| Rate for Payer: Networks By Design Commercial |
$323.05
|
| Rate for Payer: Prime Health Services Commercial |
$422.45
|
| Rate for Payer: Riverside University Health System MISP |
$198.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.20
|
| 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 |
$422.45
|
| Rate for Payer: Vantage Medical Group Senior |
$422.45
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$613.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$613.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$509.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.61
|
| Rate for Payer: Blue Distinction Transplant |
$669.60
|
| Rate for Payer: Blue Shield of California Commercial |
$837.00
|
| Rate for Payer: Blue Shield of California EPN |
$607.10
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$948.60
|
| Rate for Payer: Dignity Health Media |
$948.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$948.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$837.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$390.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Networks By Design Commercial |
$558.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Riverside University Health System MISP |
$446.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$948.60
|
| Rate for Payer: Vantage Medical Group Senior |
$948.60
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$1,004.40 |
| Rate for Payer: Blue Shield of California EPN |
$595.94
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Central Health Plan Commercial |
$892.80
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,004.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.20
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.40
|
| Rate for Payer: United Healthcare All Other HMO |
$411.58
|
| Rate for Payer: United Healthcare HMO Rider |
$402.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.28
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Blue Shield of California EPN |
$31.51
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.28
|
| Rate for Payer: United Healthcare All Other HMO |
$21.76
|
| Rate for Payer: United Healthcare HMO Rider |
$21.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.47
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.86
|
| Rate for Payer: Blue Distinction Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$44.25
|
| Rate for Payer: Blue Shield of California EPN |
$32.10
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.15
|
| Rate for Payer: Dignity Health Media |
$50.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Riverside University Health System MISP |
$23.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.50
|
| Rate for Payer: United Healthcare All Other HMO |
$29.50
|
| Rate for Payer: United Healthcare HMO Rider |
$29.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50.15
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
IP
|
$2,934.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$2,640.60 |
| Rate for Payer: Cash Price |
$1,320.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,347.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.60
|
| Rate for Payer: Galaxy Health WC |
$2,493.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,760.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,640.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Multiplan Commercial |
$2,200.50
|
| Rate for Payer: Networks By Design Commercial |
$1,907.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.90
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
OP
|
$2,934.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,420.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,733.41
|
| Rate for Payer: Blue Distinction Transplant |
$1,760.40
|
| 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 |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,320.30
|
| Rate for Payer: Cash Price |
$1,320.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,347.20
|
| Rate for Payer: Cigna of CA PPO |
$2,171.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,493.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,760.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,640.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,200.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,200.50
|
| Rate for Payer: Networks By Design Commercial |
$1,907.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,760.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,772.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.62
|
| Rate for Payer: Blue Distinction Transplant |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$242.26
|
| Rate for Payer: Blue Shield of California EPN |
$190.51
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Central Health Plan Commercial |
$313.60
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$352.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: InnovAge PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
|
IP
|
$18,817.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,763.40 |
| Max. Negotiated Rate |
$16,935.30 |
| Rate for Payer: Cash Price |
$8,467.65
|
| Rate for Payer: Central Health Plan Commercial |
$15,053.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,526.80
|
| Rate for Payer: Galaxy Health WC |
$15,994.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,290.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,935.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,169.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,763.40
|
| Rate for Payer: Multiplan Commercial |
$14,112.75
|
| Rate for Payer: Networks By Design Commercial |
$12,231.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,994.45
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
|
OP
|
$18,817.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$792.26 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,861.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$17,583.26
|
| Rate for Payer: Blue Distinction Transplant |
$11,290.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$12,861.31
|
| Rate for Payer: Cash Price |
$8,467.65
|
| Rate for Payer: Cash Price |
$8,467.65
|
| Rate for Payer: Central Health Plan Commercial |
$15,053.60
|
| Rate for Payer: Cigna of CA PPO |
$13,924.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Media |
$12,861.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,362.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,861.31
|
| Rate for Payer: Galaxy Health WC |
$15,994.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,290.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,935.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14,112.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,092.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,221.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: InnovAge PACE Commercial |
$19,291.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,861.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,763.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,234.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,234.16
|
| Rate for Payer: Multiplan Commercial |
$14,112.75
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: Networks By Design Commercial |
$12,231.05
|
| Rate for Payer: Preferred Health Network WC |
$17,942.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,994.45
|
| Rate for Payer: Prime Health Services Medicare |
$13,632.99
|
| Rate for Payer: Prime Health Services WC |
$17,403.84
|
| Rate for Payer: Riverside University Health System MISP |
$14,147.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,290.20
|
| 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 |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
OP
|
$50,076.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$29,952.68
|
| Rate for Payer: Blue Distinction Transplant |
$30,045.60
|
| 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: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: Central Health Plan Commercial |
$40,060.80
|
| Rate for Payer: Cigna of CA PPO |
$37,056.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$42,564.60
|
| Rate for Payer: Global Benefits Group Commercial |
$30,045.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,068.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37,557.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,400.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,015.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$37,557.00
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$32,549.40
|
| Rate for Payer: Preferred Health Network WC |
$30,563.96
|
| Rate for Payer: Prime Health Services Commercial |
$42,564.60
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,045.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
IP
|
$50,076.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,015.20 |
| Max. Negotiated Rate |
$45,068.40 |
| Rate for Payer: Cash Price |
$22,534.20
|
| Rate for Payer: Central Health Plan Commercial |
$40,060.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,030.40
|
| Rate for Payer: Galaxy Health WC |
$42,564.60
|
| Rate for Payer: Global Benefits Group Commercial |
$30,045.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,068.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,400.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,078.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,015.20
|
| Rate for Payer: Multiplan Commercial |
$37,557.00
|
| Rate for Payer: Networks By Design Commercial |
$32,549.40
|
| Rate for Payer: Prime Health Services Commercial |
$42,564.60
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
|
IP
|
$10,378.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,075.60 |
| Max. Negotiated Rate |
$9,340.20 |
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,151.20
|
| Rate for Payer: Galaxy Health WC |
$8,821.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,922.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,954.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.60
|
| Rate for Payer: Multiplan Commercial |
$7,783.50
|
| Rate for Payer: Networks By Design Commercial |
$6,745.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,821.30
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
|
OP
|
$10,378.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$748.39 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,226.80
|
| 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 |
$4,044.21
|
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,302.40
|
| Rate for Payer: Cigna of CA PPO |
$7,679.72
|
| 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 |
$8,821.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,340.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,783.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| 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 |
$6,922.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.60
|
| 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 |
$7,783.50
|
| Rate for Payer: Networks By Design Commercial |
$6,745.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,821.30
|
| 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 |
$6,226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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 PERQ LUMBOSACRAL INJECT
|
Facility
|
OP
|
$10,378.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$703.13 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,226.80
|
| 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 |
$4,044.21
|
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,302.40
|
| Rate for Payer: Cigna of CA PPO |
$7,679.72
|
| 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 |
$8,821.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,340.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,783.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| 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 |
$6,922.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.60
|
| 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 |
$7,783.50
|
| Rate for Payer: Networks By Design Commercial |
$6,745.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,821.30
|
| 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 |
$6,226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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 PERQ LUMBOSACRAL INJECT
|
Facility
|
IP
|
$10,378.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,075.60 |
| Max. Negotiated Rate |
$9,340.20 |
| Rate for Payer: Cash Price |
$4,670.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,151.20
|
| Rate for Payer: Galaxy Health WC |
$8,821.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,922.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,954.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.60
|
| Rate for Payer: Multiplan Commercial |
$7,783.50
|
| Rate for Payer: Networks By Design Commercial |
$6,745.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,821.30
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,048.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$904.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$904.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$986.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: Cigna of CA PPO |
$1,216.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,397.40
|
| Rate for Payer: Dignity Health Media |
$1,397.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,233.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$1,068.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
| Rate for Payer: Riverside University Health System MISP |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$986.40
|
| 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 |
$1,397.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,397.40
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$657.60
|
| Rate for Payer: Galaxy Health WC |
$1,397.40
|
| Rate for Payer: Global Benefits Group Commercial |
$986.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,479.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,096.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,397.40
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
OP
|
$29,863.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$26,876.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,089.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,383.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,424.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,424.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,254.00
|
| Rate for Payer: Blue Distinction Transplant |
$17,917.80
|
| 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 |
$13,438.35
|
| Rate for Payer: Cash Price |
$13,438.35
|
| Rate for Payer: Cash Price |
$13,438.35
|
| Rate for Payer: Central Health Plan Commercial |
$23,890.40
|
| Rate for Payer: Cigna of CA PPO |
$22,098.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,383.55
|
| Rate for Payer: Dignity Health Media |
$25,383.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,383.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,945.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,945.20
|
| Rate for Payer: Galaxy Health WC |
$25,383.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,917.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,876.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22,397.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,452.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,377.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,972.60
|
| Rate for Payer: Multiplan Commercial |
$22,397.25
|
| Rate for Payer: Networks By Design Commercial |
$19,410.95
|
| Rate for Payer: Prime Health Services Commercial |
$25,383.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,945.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,917.80
|
| 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 |
$25,383.55
|
| Rate for Payer: Vantage Medical Group Senior |
$25,383.55
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
IP
|
$29,863.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,972.60 |
| Max. Negotiated Rate |
$26,876.70 |
| Rate for Payer: Cash Price |
$13,438.35
|
| Rate for Payer: Central Health Plan Commercial |
$23,890.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,945.20
|
| Rate for Payer: Galaxy Health WC |
$25,383.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,917.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,876.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,377.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,972.60
|
| Rate for Payer: Multiplan Commercial |
$22,397.25
|
| Rate for Payer: Networks By Design Commercial |
$19,410.95
|
| Rate for Payer: Prime Health Services Commercial |
$25,383.55
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906820005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,073.99 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,908.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| 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 |
$28,992.60
|
| 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: Caremore Medicare Advantage |
$21,908.96
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Central Health Plan Commercial |
$38,656.80
|
| Rate for Payer: Cigna of CA PPO |
$35,757.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$41,072.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,488.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36,240.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,149.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: InnovAge PACE Commercial |
$32,863.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,230.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,664.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,358.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$36,240.75
|
| Rate for Payer: Networks By Design Commercial |
$31,408.65
|
| Rate for Payer: Prime Health Services Commercial |
$41,072.85
|
| Rate for Payer: Prime Health Services Medicare |
$23,223.50
|
| Rate for Payer: Riverside University Health System MISP |
$24,099.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906820005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,664.20 |
| Max. Negotiated Rate |
$43,488.90 |
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Central Health Plan Commercial |
$38,656.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,328.40
|
| Rate for Payer: Galaxy Health WC |
$41,072.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,488.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,230.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,410.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,664.20
|
| Rate for Payer: Multiplan Commercial |
$36,240.75
|
| Rate for Payer: Networks By Design Commercial |
$31,408.65
|
| Rate for Payer: Prime Health Services Commercial |
$41,072.85
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,664.20 |
| Max. Negotiated Rate |
$43,488.90 |
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Central Health Plan Commercial |
$38,656.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,328.40
|
| Rate for Payer: Galaxy Health WC |
$41,072.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,488.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,230.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,410.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,664.20
|
| Rate for Payer: Multiplan Commercial |
$36,240.75
|
| Rate for Payer: Networks By Design Commercial |
$31,408.65
|
| Rate for Payer: Prime Health Services Commercial |
$41,072.85
|
|
