|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
906820028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$656.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA PPO |
$809.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$820.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| 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 Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$656.40
|
| Rate for Payer: Blue Shield of California Commercial |
$688.13
|
| Rate for Payer: Blue Shield of California EPN |
$534.97
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$700.16
|
| Rate for Payer: Cigna of CA PPO |
$809.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$820.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$656.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA PPO |
$809.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$820.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| 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 Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC PUNCTURE PERITONEAL CAVITY W IMAGING GUIDANCE
|
Facility
|
IP
|
$2,110.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
904000016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$1,899.00 |
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,688.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$844.00
|
| Rate for Payer: Galaxy Health WC |
$1,793.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,266.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,899.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,407.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$803.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.00
|
| Rate for Payer: Multiplan Commercial |
$1,582.50
|
| Rate for Payer: Networks By Design Commercial |
$1,371.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,793.50
|
|
|
HC PUNCTURE PERITONEAL CAVITY W IMAGING GUIDANCE
|
Facility
|
OP
|
$2,110.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
904000016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,266.00
|
| 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 |
$949.50
|
| Rate for Payer: Cash Price |
$949.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,688.00
|
| Rate for Payer: Cigna of CA PPO |
$1,561.40
|
| 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 |
$1,793.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,266.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,899.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,582.50
|
| 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 |
$1,407.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.00
|
| 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 |
$1,582.50
|
| Rate for Payer: Networks By Design Commercial |
$1,371.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,793.50
|
| 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 |
$1,266.00
|
| 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 PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$1,799.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,079.40
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,439.20
|
| Rate for Payer: Cigna of CA PPO |
$1,331.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,619.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,349.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,349.25
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,079.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.50
|
| Rate for Payer: United Healthcare All Other HMO |
$899.50
|
| Rate for Payer: United Healthcare HMO Rider |
$899.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$899.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$1,799.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$1,619.10 |
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,439.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$719.60
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,619.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$1,349.25
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$1,799.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$1,619.10 |
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,439.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$719.60
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,619.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$1,349.25
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$1,799.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| 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 |
$1,079.40
|
| 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 |
$864.04
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,439.20
|
| Rate for Payer: Cigna of CA PPO |
$1,331.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,619.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,349.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,349.25
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,079.40
|
| 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 Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC PVA PARTICLES
|
Facility
|
OP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$1,014.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$619.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$514.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$627.74
|
| Rate for Payer: Blue Distinction Transplant |
$676.20
|
| Rate for Payer: Blue Shield of California Commercial |
$845.25
|
| Rate for Payer: Blue Shield of California EPN |
$613.09
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Central Health Plan Commercial |
$901.60
|
| Rate for Payer: Cigna of CA HMO |
$788.90
|
| Rate for Payer: Cigna of CA PPO |
$788.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$957.95
|
| Rate for Payer: Dignity Health Media |
$957.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$957.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$450.80
|
| Rate for Payer: Galaxy Health WC |
$957.95
|
| Rate for Payer: Global Benefits Group Commercial |
$676.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,014.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$845.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$394.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: Networks By Design Commercial |
$563.50
|
| Rate for Payer: Prime Health Services Commercial |
$957.95
|
| Rate for Payer: Riverside University Health System MISP |
$450.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$676.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$676.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$563.50
|
| Rate for Payer: United Healthcare All Other HMO |
$563.50
|
| Rate for Payer: United Healthcare HMO Rider |
$563.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$957.95
|
| Rate for Payer: Vantage Medical Group Senior |
$957.95
|
|
|
HC PVA PARTICLES
|
Facility
|
IP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$1,014.30 |
| Rate for Payer: Blue Shield of California EPN |
$601.82
|
| Rate for Payer: Cash Price |
$507.15
|
| Rate for Payer: Central Health Plan Commercial |
$901.60
|
| Rate for Payer: Cigna of CA HMO |
$788.90
|
| Rate for Payer: Cigna of CA PPO |
$788.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$450.80
|
| Rate for Payer: Galaxy Health WC |
$957.95
|
| Rate for Payer: Global Benefits Group Commercial |
$676.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,014.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$845.25
|
| Rate for Payer: Prime Health Services Commercial |
$957.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.56
|
| Rate for Payer: United Healthcare All Other HMO |
$415.64
|
| Rate for Payer: United Healthcare HMO Rider |
$406.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.91
|
|
|
HC PWRWAND CATH ED STERILE 3FR
|
Facility
|
OP
|
$440.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$242.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.53
|
| Rate for Payer: Blue Distinction Transplant |
$264.58
|
| Rate for Payer: Blue Shield of California Commercial |
$277.37
|
| Rate for Payer: Blue Shield of California EPN |
$215.63
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Central Health Plan Commercial |
$352.78
|
| Rate for Payer: Cigna of CA HMO |
$282.22
|
| Rate for Payer: Cigna of CA PPO |
$326.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.82
|
| Rate for Payer: Dignity Health Media |
$374.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$176.39
|
| Rate for Payer: Galaxy Health WC |
$374.82
|
| Rate for Payer: Global Benefits Group Commercial |
$264.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$330.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$154.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.19
|
| Rate for Payer: Multiplan Commercial |
$330.73
|
| Rate for Payer: Networks By Design Commercial |
$286.63
|
| Rate for Payer: Prime Health Services Commercial |
$374.82
|
| Rate for Payer: Riverside University Health System MISP |
$176.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.48
|
| Rate for Payer: United Healthcare All Other HMO |
$220.48
|
| Rate for Payer: United Healthcare HMO Rider |
$220.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.82
|
| Rate for Payer: Vantage Medical Group Senior |
$374.82
|
|
|
HC PWRWAND CATH ED STERILE 3FR
|
Facility
|
IP
|
$440.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$396.87 |
| Rate for Payer: Cash Price |
$198.44
|
| Rate for Payer: Central Health Plan Commercial |
$352.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.39
|
| Rate for Payer: Galaxy Health WC |
$374.82
|
| Rate for Payer: Global Benefits Group Commercial |
$264.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.19
|
| Rate for Payer: Multiplan Commercial |
$330.73
|
| Rate for Payer: Networks By Design Commercial |
$286.63
|
| Rate for Payer: Prime Health Services Commercial |
$374.82
|
|
|
HC PWRWAND XL 3FR 6CM QUICK KIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.67
|
| Rate for Payer: Blue Distinction Transplant |
$73.80
|
| Rate for Payer: Blue Shield of California Commercial |
$77.37
|
| Rate for Payer: Blue Shield of California EPN |
$60.15
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.55
|
| Rate for Payer: Dignity Health Media |
$104.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$92.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Riverside University Health System MISP |
$49.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO |
$61.50
|
| Rate for Payer: United Healthcare HMO Rider |
$61.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.55
|
| Rate for Payer: Vantage Medical Group Senior |
$104.55
|
|
|
HC PWRWAND XL 3FR 6CM QUICK KIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.67
|
| Rate for Payer: Blue Distinction Transplant |
$73.80
|
| Rate for Payer: Blue Shield of California Commercial |
$77.37
|
| Rate for Payer: Blue Shield of California EPN |
$60.15
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.55
|
| Rate for Payer: Dignity Health Media |
$104.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$92.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Riverside University Health System MISP |
$49.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO |
$61.50
|
| Rate for Payer: United Healthcare HMO Rider |
$61.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.55
|
| Rate for Payer: Vantage Medical Group Senior |
$104.55
|
|
|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Central Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.60
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
OP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.72
|
| Rate for Payer: Blue Distinction Transplant |
$250.56
|
| Rate for Payer: Blue Shield of California Commercial |
$262.67
|
| Rate for Payer: Blue Shield of California EPN |
$204.21
|
| Rate for Payer: Cash Price |
$187.92
|
| Rate for Payer: Cash Price |
$187.92
|
| Rate for Payer: Central Health Plan Commercial |
$334.08
|
| Rate for Payer: Cigna of CA HMO |
$267.26
|
| Rate for Payer: Cigna of CA PPO |
$309.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.96
|
| Rate for Payer: Dignity Health Media |
$354.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$313.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$146.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Multiplan Commercial |
$313.20
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
| Rate for Payer: Riverside University Health System MISP |
$167.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.80
|
| Rate for Payer: United Healthcare All Other HMO |
$208.80
|
| Rate for Payer: United Healthcare HMO Rider |
$208.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.96
|
| Rate for Payer: Vantage Medical Group Senior |
$354.96
|
|
|
HC PWRWAND XL SINGLE 3FR, 6CM
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Cash Price |
$187.92
|
| Rate for Payer: Central Health Plan Commercial |
$334.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.04
|
| Rate for Payer: Galaxy Health WC |
$354.96
|
| Rate for Payer: Global Benefits Group Commercial |
$250.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Multiplan Commercial |
$313.20
|
| Rate for Payer: Networks By Design Commercial |
$271.44
|
| Rate for Payer: Prime Health Services Commercial |
$354.96
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
OP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$278.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$339.24
|
| Rate for Payer: Blue Distinction Transplant |
$344.52
|
| Rate for Payer: Blue Shield of California Commercial |
$361.17
|
| Rate for Payer: Blue Shield of California EPN |
$280.78
|
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: Central Health Plan Commercial |
$459.36
|
| Rate for Payer: Cigna of CA HMO |
$367.49
|
| Rate for Payer: Cigna of CA PPO |
$424.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.07
|
| Rate for Payer: Dignity Health Media |
$488.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$488.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$430.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.84
|
| Rate for Payer: Multiplan Commercial |
$430.65
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
| Rate for Payer: Riverside University Health System MISP |
$229.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO |
$287.10
|
| Rate for Payer: United Healthcare HMO Rider |
$287.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$488.07
|
| Rate for Payer: Vantage Medical Group Senior |
$488.07
|
|
|
HC PWRWAND XL SINGLE 4FR, 8CM
|
Facility
|
IP
|
$574.20
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.84 |
| Max. Negotiated Rate |
$516.78 |
| Rate for Payer: Cash Price |
$258.39
|
| Rate for Payer: Central Health Plan Commercial |
$459.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.68
|
| Rate for Payer: Galaxy Health WC |
$488.07
|
| Rate for Payer: Global Benefits Group Commercial |
$344.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.84
|
| Rate for Payer: Multiplan Commercial |
$430.65
|
| Rate for Payer: Networks By Design Commercial |
$373.23
|
| Rate for Payer: Prime Health Services Commercial |
$488.07
|
|
|
HC PYRUVATE
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC PYRUVATE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$96.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.36
|
| Rate for Payer: Blue Distinction Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Caremore Medicare Advantage |
$14.48
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Media |
$14.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: InnovAge PACE Commercial |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Medicare |
$15.35
|
| Rate for Payer: Riverside University Health System MISP |
$15.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
|
HC PYRUVATE CSF
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
900910344
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$96.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.36
|
| Rate for Payer: Blue Distinction Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Caremore Medicare Advantage |
$14.48
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.72
|
| Rate for Payer: Dignity Health Media |
$14.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.48
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.48
|
| Rate for Payer: InnovAge PACE Commercial |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.40
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Medicare |
$15.35
|
| Rate for Payer: Riverside University Health System MISP |
$15.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.73
|
| Rate for Payer: United Healthcare All Other HMO |
$11.73
|
| Rate for Payer: United Healthcare HMO Rider |
$11.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.93
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
