|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Senior |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,851.20 |
| Max. Negotiated Rate |
$8,330.40 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,702.40
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,526.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,729.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$8,330.40 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: Cigna of CA HMO |
$5,923.84
|
| Rate for Payer: Cigna of CA PPO |
$6,849.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,553.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$8,330.40 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: Cigna of CA HMO |
$5,923.84
|
| Rate for Payer: Cigna of CA PPO |
$6,849.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,553.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,851.20 |
| Max. Negotiated Rate |
$8,330.40 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Cash Price |
$4,165.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,702.40
|
| Rate for Payer: Galaxy Health WC |
$7,867.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,553.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,330.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,526.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,729.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.20
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| Rate for Payer: Networks By Design Commercial |
$6,016.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,867.60
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$663.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$302.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.38
|
| Rate for Payer: Blue Shield of California Commercial |
$663.45
|
| Rate for Payer: Blue Shield of California EPN |
$433.92
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$676.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$571.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.04 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$561.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$478.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.20
|
| Rate for Payer: Blue Shield of California Commercial |
$560.87
|
| Rate for Payer: Blue Shield of California EPN |
$366.83
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: Cigna of CA HMO |
$591.36
|
| Rate for Payer: Cigna of CA PPO |
$683.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$554.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Blue Shield of California Commercial |
$84.55
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.88
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$71.10
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.24
|
| Rate for Payer: Blue Shield of California Commercial |
$84.55
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: InnovAge PACE Commercial |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Riverside University Health System MISP |
$43.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.24
|
| Rate for Payer: Blue Shield of California Commercial |
$84.55
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: InnovAge PACE Commercial |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Riverside University Health System MISP |
$43.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Blue Shield of California Commercial |
$84.55
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.88
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$71.10
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.29
|
| Rate for Payer: Blue Shield of California Commercial |
$153.05
|
| Rate for Payer: Blue Shield of California EPN |
$99.79
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: InnovAge PACE Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$99.00
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Riverside University Health System MISP |
$79.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Blue Shield of California Commercial |
$153.05
|
| Rate for Payer: Blue Shield of California EPN |
$99.79
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
|
|
HC REVERSE MVP MICRO VASC PLUG
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
906812754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,814.20 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,573.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,330.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,178.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,052.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,488.98
|
| Rate for Payer: Blue Shield of California Commercial |
$2,589.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,690.96
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,390.40
|
| Rate for Payer: Cigna of CA HMO |
$2,712.32
|
| Rate for Payer: Cigna of CA PPO |
$3,136.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,602.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,602.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,814.20
|
| Rate for Payer: InnovAge PACE Commercial |
$2,119.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,966.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,966.60
|
| Rate for Payer: Multiplan Commercial |
$3,178.50
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,695.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,542.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,542.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,119.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,602.30
|
|
|
HC REVERSE MVP MICRO VASC PLUG
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
906812754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,814.20 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.60
|
| Rate for Payer: Multiplan Commercial |
$3,178.50
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$47,412.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,482.40 |
| Max. Negotiated Rate |
$42,670.80 |
| Rate for Payer: Adventist Health Commercial |
$9,482.40
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Central Health Plan Commercial |
$37,929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,964.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18,964.80
|
| Rate for Payer: Galaxy Health WC |
$40,300.20
|
| Rate for Payer: Global Benefits Group Commercial |
$28,447.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,623.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,063.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,348.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,482.40
|
| Rate for Payer: Multiplan Commercial |
$35,559.00
|
| Rate for Payer: Networks By Design Commercial |
$30,817.80
|
| Rate for Payer: Prime Health Services Commercial |
$40,300.20
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$47,412.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.67 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,482.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Central Health Plan Commercial |
$37,929.60
|
| Rate for Payer: Cigna of CA HMO |
$30,343.68
|
| Rate for Payer: Cigna of CA PPO |
$35,084.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$40,300.20
|
| Rate for Payer: Global Benefits Group Commercial |
$28,447.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,670.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$429.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,623.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,482.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$35,559.00
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$30,817.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$40,300.20
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,447.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC REVISION OF EYELID
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,123.60 |
| Max. Negotiated Rate |
$5,056.20 |
| Rate for Payer: Adventist Health Commercial |
$1,123.60
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,247.20
|
| Rate for Payer: Galaxy Health WC |
$4,775.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,056.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,747.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,140.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,477.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.60
|
| Rate for Payer: Multiplan Commercial |
$4,213.50
|
| Rate for Payer: Networks By Design Commercial |
$3,651.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,775.30
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.82 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,123.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,494.40
|
| Rate for Payer: Cigna of CA HMO |
$3,595.52
|
| Rate for Payer: Cigna of CA PPO |
$4,157.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$4,775.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,056.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,747.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$4,213.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$3,651.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$4,775.30
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,809.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,809.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,809.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,809.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC REV KNUCKLE BENDER W/OUTRIGGER
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$93.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.32
|
| Rate for Payer: Blue Shield of California Commercial |
$175.47
|
| Rate for Payer: Blue Shield of California EPN |
$114.41
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: InnovAge PACE Commercial |
$113.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.90
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Riverside University Health System MISP |
$90.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC REV KNUCKLE BENDER W/OUTRIGGER
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Blue Shield of California Commercial |
$175.47
|
| Rate for Payer: Blue Shield of California EPN |
$114.41
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
OP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Central Health Plan Commercial |
$38,787.20
|
| Rate for Payer: Cigna of CA HMO |
$31,029.76
|
| Rate for Payer: Cigna of CA PPO |
$35,878.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,635.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,338.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,696.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$36,363.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,090.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
IP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,696.80 |
| Max. Negotiated Rate |
$43,635.60 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Central Health Plan Commercial |
$38,787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,393.60
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,635.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,338.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,472.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,011.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,696.80
|
| Rate for Payer: Multiplan Commercial |
$36,363.00
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
|
