|
HC REMOVE CERCLAGE SUTURE
|
Facility
|
OP
|
$9,308.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
902400749
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$256.08 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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 |
$5,584.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,854.73
|
| Rate for Payer: Blue Shield of California EPN |
$4,551.61
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,446.40
|
| Rate for Payer: Cigna of CA HMO |
$5,957.12
|
| Rate for Payer: Cigna of CA PPO |
$6,887.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,911.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,584.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,377.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,981.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,208.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,861.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,981.00
|
| Rate for Payer: Networks By Design Commercial |
$6,050.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,911.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,584.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,584.80
|
| 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 |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
|
IP
|
$6,103.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,220.60 |
| Max. Negotiated Rate |
$5,492.70 |
| Rate for Payer: Cash Price |
$2,746.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,882.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,441.20
|
| Rate for Payer: Galaxy Health WC |
$5,187.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,492.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,070.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,325.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.60
|
| Rate for Payer: Multiplan Commercial |
$4,577.25
|
| Rate for Payer: Networks By Design Commercial |
$3,966.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,187.55
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
|
OP
|
$6,103.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,220.60 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,661.80
|
| 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 |
$3,982.55
|
| Rate for Payer: Cash Price |
$2,746.35
|
| Rate for Payer: Cash Price |
$2,746.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,882.40
|
| Rate for Payer: Cigna of CA PPO |
$4,516.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$5,187.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,492.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,577.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,070.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,383.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$4,577.25
|
| Rate for Payer: Networks By Design Commercial |
$3,966.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,187.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
|
OP
|
$9,635.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$802.16 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,465.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| 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 |
$5,781.00
|
| 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 |
$6,465.01
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: Cigna of CA PPO |
$7,129.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Media |
$6,465.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,226.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,602.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,667.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,465.01
|
| Rate for Payer: InnovAge PACE Commercial |
$9,697.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,663.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
| Rate for Payer: Prime Health Services Medicare |
$6,852.91
|
| Rate for Payer: Riverside University Health System MISP |
$7,111.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,781.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
|
IP
|
$9,635.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,927.00 |
| Max. Negotiated Rate |
$8,671.50 |
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,854.00
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,670.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
IP
|
$9,635.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,927.00 |
| Max. Negotiated Rate |
$8,671.50 |
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,854.00
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,670.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
OP
|
$9,635.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$948.58 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,465.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| 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 |
$5,781.00
|
| 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 |
$6,465.01
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,708.00
|
| Rate for Payer: Cigna of CA PPO |
$7,129.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Media |
$6,465.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$8,189.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,781.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,671.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,226.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,602.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,667.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,465.01
|
| Rate for Payer: InnovAge PACE Commercial |
$9,697.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,426.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,663.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: Networks By Design Commercial |
$6,262.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,189.75
|
| Rate for Payer: Prime Health Services Medicare |
$6,852.91
|
| Rate for Payer: Riverside University Health System MISP |
$7,111.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,781.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
IP
|
$2,874.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$574.80 |
| Max. Negotiated Rate |
$2,586.60 |
| Rate for Payer: Cash Price |
$1,293.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,149.60
|
| Rate for Payer: Galaxy Health WC |
$2,442.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,724.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,586.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,094.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.80
|
| Rate for Payer: Multiplan Commercial |
$2,155.50
|
| Rate for Payer: Networks By Design Commercial |
$1,868.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,442.90
|
|
|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
OP
|
$2,874.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$574.80 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,724.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,293.30
|
| Rate for Payer: Cash Price |
$1,293.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,299.20
|
| Rate for Payer: Cigna of CA PPO |
$2,126.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,442.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,724.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,586.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,155.50
|
| 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 |
$1,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,155.50
|
| Rate for Payer: Networks By Design Commercial |
$1,868.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,442.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,724.40
|
| 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 REMOVE PERICATH OBSTRUCTION
|
Facility
|
OP
|
$3,664.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.78 |
| Max. Negotiated Rate |
$3,297.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$805.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,114.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,015.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,015.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$380.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$464.24
|
| Rate for Payer: Blue Distinction Transplant |
$2,198.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,264.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,780.70
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,931.20
|
| Rate for Payer: Cigna of CA HMO |
$2,344.96
|
| Rate for Payer: Cigna of CA PPO |
$2,711.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,114.40
|
| Rate for Payer: Dignity Health Media |
$3,114.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,465.60
|
| Rate for Payer: Galaxy Health WC |
$3,114.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,198.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,297.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,748.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,282.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,443.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.80
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: Networks By Design Commercial |
$2,381.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,114.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,465.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,198.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,198.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,832.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,832.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,832.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,114.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,114.40
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
|
IP
|
$3,664.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$732.80 |
| Max. Negotiated Rate |
$3,297.60 |
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,931.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.60
|
| Rate for Payer: Galaxy Health WC |
$3,114.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,198.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,297.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,443.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,395.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.80
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: Networks By Design Commercial |
$2,381.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,114.40
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
IP
|
$10,382.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,076.40 |
| Max. Negotiated Rate |
$9,343.80 |
| Rate for Payer: Cash Price |
$4,671.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,152.80
|
| Rate for Payer: Galaxy Health WC |
$8,824.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,343.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,924.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,955.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.40
|
| Rate for Payer: Multiplan Commercial |
$7,786.50
|
| Rate for Payer: Networks By Design Commercial |
$6,748.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,824.70
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
OP
|
$10,382.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$597.72 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,229.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,671.90
|
| Rate for Payer: Cash Price |
$4,671.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,305.60
|
| Rate for Payer: Cigna of CA PPO |
$7,682.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,824.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,343.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,786.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,924.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,786.50
|
| Rate for Payer: Networks By Design Commercial |
$6,748.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,824.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
IP
|
$10,382.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,076.40 |
| Max. Negotiated Rate |
$9,343.80 |
| Rate for Payer: Cash Price |
$4,671.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,152.80
|
| Rate for Payer: Galaxy Health WC |
$8,824.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,343.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,924.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,955.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.40
|
| Rate for Payer: Multiplan Commercial |
$7,786.50
|
| Rate for Payer: Networks By Design Commercial |
$6,748.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,824.70
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
OP
|
$10,382.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$597.72 |
| Max. Negotiated Rate |
$9,343.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,229.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,530.28
|
| Rate for Payer: Blue Shield of California EPN |
$5,076.80
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,671.90
|
| Rate for Payer: Cash Price |
$4,671.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,305.60
|
| Rate for Payer: Cigna of CA HMO |
$6,644.48
|
| Rate for Payer: Cigna of CA PPO |
$7,682.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,824.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,343.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,786.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,924.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,786.50
|
| Rate for Payer: Networks By Design Commercial |
$6,748.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,824.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,229.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,191.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,191.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.60 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$853.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.50
|
| 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 |
$1,315.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$853.50
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,754.40
|
| Rate for Payer: Cigna of CA PPO |
$1,622.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Media |
$853.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$853.50
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,973.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,644.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,408.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$853.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,280.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$863.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.69
|
| Rate for Payer: Multiplan Commercial |
$1,644.75
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
| Rate for Payer: Prime Health Services Medicare |
$904.71
|
| Rate for Payer: Riverside University Health System MISP |
$938.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.60 |
| Max. Negotiated Rate |
$1,973.70 |
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.20
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,973.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.60
|
| Rate for Payer: Multiplan Commercial |
$1,644.75
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.19 |
| Max. Negotiated Rate |
$5,242.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| 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 |
$3,495.00
|
| 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 |
$784.90
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,660.00
|
| Rate for Payer: Cigna of CA PPO |
$4,310.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,242.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,368.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$4,368.75
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,495.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,165.00 |
| Max. Negotiated Rate |
$5,242.50 |
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,330.00
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,242.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,219.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.00
|
| Rate for Payer: Multiplan Commercial |
$4,368.75
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.19 |
| Max. Negotiated Rate |
$5,242.50 |
| 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 |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| 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 |
$3,495.00
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,660.00
|
| Rate for Payer: Cigna of CA PPO |
$4,310.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,242.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,368.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$4,368.75
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,495.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,912.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,912.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,165.00 |
| Max. Negotiated Rate |
$5,242.50 |
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,330.00
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,242.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,219.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.00
|
| Rate for Payer: Multiplan Commercial |
$4,368.75
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.19 |
| Max. Negotiated Rate |
$5,242.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| 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 |
$3,495.00
|
| 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 |
$784.90
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,660.00
|
| Rate for Payer: Cigna of CA PPO |
$4,310.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,242.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,368.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$4,368.75
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,495.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,165.00 |
| Max. Negotiated Rate |
$5,242.50 |
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,330.00
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,242.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,219.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,165.00
|
| Rate for Payer: Multiplan Commercial |
$4,368.75
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
|
|
HC REMOVE TUNNEL PLEURAL CATH
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$2,587.50 |
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,587.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.00
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Networks By Design Commercial |
$1,868.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
|
|
HC REMOVE TUNNEL PLEURAL CATH
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$290.02 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| 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 |
$1,725.00
|
| 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 |
$784.90
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,300.00
|
| Rate for Payer: Cigna of CA PPO |
$2,127.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,587.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,156.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Networks By Design Commercial |
$1,868.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,725.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
