|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$581.97 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$581.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$189.44
|
| Rate for Payer: Cigna of CA PPO |
$219.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Riverside University Health System MISP |
$118.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC SENSURA MIO OSTOMY KIT RED
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT RED
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT YELLOW
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT YELLOW
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC SEO SUPINATOR
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT L3974
|
| Hospital Charge Code |
903203974
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.71
|
| Rate for Payer: Blue Shield of California Commercial |
$114.12
|
| Rate for Payer: Blue Shield of California EPN |
$71.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$115.20
|
| Rate for Payer: Cigna of CA PPO |
$133.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Riverside University Health System MISP |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SEO SUPINATOR
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT L3974
|
| Hospital Charge Code |
903203974
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
|
HC SEP LOWER LIMBS
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
900600223
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,888.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$944.00
|
| Rate for Payer: EPIC Health Plan Senior |
$944.00
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,124.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,392.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
|
|
HC SEP LOWER LIMBS
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
900600223
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$211.82 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$808.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,372.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,486.80
|
| Rate for Payer: Blue Shield of California EPN |
$936.92
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,888.00
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,124.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$460.38 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,104.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,550.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,322.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,429.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,631.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,658.27
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: Cigna of CA HMO |
$2,673.28
|
| Rate for Payer: Cigna of CA PPO |
$3,090.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,214.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,104.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,923.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,822.39
|
| Rate for Payer: EPIC Health Plan Senior |
$1,214.93
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,811.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$460.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,652.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$508.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,546.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,480.00
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,104.48
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,170.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,214.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,506.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,506.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,104.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,656.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,214.93
|
| Rate for Payer: Vantage Medical Group Senior |
$1,104.48
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
IP
|
$4,177.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$835.40 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,923.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,670.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,670.80
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,652.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,464.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
|
|
HC SEP, UPPER LIMBS
|
Facility
|
OP
|
$3,261.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
900600220
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$2,934.90 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$844.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$365.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,896.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,054.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,294.62
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,608.80
|
| Rate for Payer: Cigna of CA HMO |
$2,087.04
|
| Rate for Payer: Cigna of CA PPO |
$2,413.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,282.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,934.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,070.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$2,445.75
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,956.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC SEP, UPPER LIMBS
|
Facility
|
IP
|
$3,261.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
900600220
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,934.90 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,608.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,282.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.40
|
| Rate for Payer: Galaxy Health WC |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,934.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,070.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,923.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.20
|
| Rate for Payer: Multiplan Commercial |
$2,445.75
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
|
|
HC SES I 1 (SESAME), IGE
|
Facility
|
IP
|
$16.46
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$14.81 |
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Central Health Plan Commercial |
$13.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.58
|
| Rate for Payer: EPIC Health Plan Senior |
$6.58
|
| Rate for Payer: Galaxy Health WC |
$13.99
|
| Rate for Payer: Global Benefits Group Commercial |
$9.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$12.35
|
| Rate for Payer: Networks By Design Commercial |
$10.70
|
| Rate for Payer: Prime Health Services Commercial |
$13.99
|
|
|
HC SES I 1 (SESAME), IGE
|
Facility
|
OP
|
$13.72
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Adventist Health Commercial |
$3.29
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$10.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8.64
|
| Rate for Payer: Blue Shield of California EPN |
$6.53
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.98
|
| Rate for Payer: Central Health Plan Commercial |
$13.17
|
| Rate for Payer: Cigna of CA HMO |
$10.53
|
| Rate for Payer: Cigna of CA HMO |
$8.78
|
| Rate for Payer: Cigna of CA PPO |
$12.18
|
| Rate for Payer: Cigna of CA PPO |
$10.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$13.99
|
| Rate for Payer: Galaxy Health WC |
$11.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.88
|
| Rate for Payer: Global Benefits Group Commercial |
$8.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$12.35
|
| Rate for Payer: Multiplan Commercial |
$10.29
|
| Rate for Payer: Networks By Design Commercial |
$8.92
|
| Rate for Payer: Networks By Design Commercial |
$10.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.66
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.68
|
| Rate for Payer: Blue Shield of California Commercial |
$108.64
|
| Rate for Payer: Blue Shield of California EPN |
$68.37
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Cigna of CA HMO |
$109.67
|
| Rate for Payer: Cigna of CA PPO |
$126.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.95
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
| Rate for Payer: Riverside University Health System MISP |
$68.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.68
|
| Rate for Payer: United Healthcare All Other HMO |
$85.68
|
| Rate for Payer: United Healthcare HMO Rider |
$85.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.66
|
| Rate for Payer: Vantage Medical Group Senior |
$145.66
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.68
|
| Rate for Payer: Blue Shield of California Commercial |
$108.64
|
| Rate for Payer: Blue Shield of California EPN |
$68.37
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Cigna of CA HMO |
$109.67
|
| Rate for Payer: Cigna of CA PPO |
$126.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.95
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
| Rate for Payer: Riverside University Health System MISP |
$68.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.68
|
| Rate for Payer: United Healthcare All Other HMO |
$85.68
|
| Rate for Payer: United Healthcare HMO Rider |
$85.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.66
|
| Rate for Payer: Vantage Medical Group Senior |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.68
|
| Rate for Payer: Blue Shield of California Commercial |
$108.64
|
| Rate for Payer: Blue Shield of California EPN |
$68.37
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Cigna of CA HMO |
$109.67
|
| Rate for Payer: Cigna of CA PPO |
$126.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.95
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
| Rate for Payer: Riverside University Health System MISP |
$68.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.68
|
| Rate for Payer: United Healthcare All Other HMO |
$85.68
|
| Rate for Payer: United Healthcare HMO Rider |
$85.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.66
|
| Rate for Payer: Vantage Medical Group Senior |
$145.66
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
IP
|
$87.55
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Adventist Health Commercial |
$17.51
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.02
|
| Rate for Payer: EPIC Health Plan Senior |
$35.02
|
| Rate for Payer: Galaxy Health WC |
$74.42
|
| Rate for Payer: Global Benefits Group Commercial |
$52.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$65.66
|
| Rate for Payer: Networks By Design Commercial |
$56.91
|
| Rate for Payer: Prime Health Services Commercial |
$74.42
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
OP
|
$87.55
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Adventist Health Commercial |
$17.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.93
|
| Rate for Payer: Blue Shield of California Commercial |
$55.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.93
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.04
|
| Rate for Payer: Cigna of CA HMO |
$56.03
|
| Rate for Payer: Cigna of CA PPO |
$64.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.02
|
| Rate for Payer: EPIC Health Plan Senior |
$35.02
|
| Rate for Payer: Galaxy Health WC |
$74.42
|
| Rate for Payer: Global Benefits Group Commercial |
$52.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.28
|
| Rate for Payer: Multiplan Commercial |
$65.66
|
| Rate for Payer: Networks By Design Commercial |
$56.91
|
| Rate for Payer: Prime Health Services Commercial |
$74.42
|
| Rate for Payer: Riverside University Health System MISP |
$35.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.77
|
| Rate for Payer: United Healthcare All Other HMO |
$43.77
|
| Rate for Payer: United Healthcare HMO Rider |
$43.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.42
|
| Rate for Payer: Vantage Medical Group Senior |
$74.42
|
|
|
HC SET DIALYNATE PERITONEAL
|
Facility
|
OP
|
$573.62
|
|
| Hospital Charge Code |
901605981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$516.26 |
| Rate for Payer: Adventist Health Commercial |
$114.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.67
|
| Rate for Payer: Blue Shield of California Commercial |
$363.68
|
| Rate for Payer: Blue Shield of California EPN |
$228.87
|
| Rate for Payer: Cash Price |
$258.13
|
| Rate for Payer: Central Health Plan Commercial |
$458.90
|
| Rate for Payer: Cigna of CA HMO |
$367.12
|
| Rate for Payer: Cigna of CA PPO |
$424.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$487.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$401.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: EPIC Health Plan Senior |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$364.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$338.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$401.53
|
| Rate for Payer: Multiplan Commercial |
$430.21
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
| Rate for Payer: Riverside University Health System MISP |
$229.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.81
|
| Rate for Payer: United Healthcare All Other HMO |
$286.81
|
| Rate for Payer: United Healthcare HMO Rider |
$286.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.58
|
| Rate for Payer: Vantage Medical Group Senior |
$487.58
|
|
|
HC SET DIALYNATE PERITONEAL
|
Facility
|
IP
|
$573.62
|
|
| Hospital Charge Code |
901605981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$516.26 |
| Rate for Payer: Adventist Health Commercial |
$114.72
|
| Rate for Payer: Cash Price |
$258.13
|
| Rate for Payer: Central Health Plan Commercial |
$458.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$401.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: EPIC Health Plan Senior |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$364.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$338.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$430.21
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
|
