|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$189.44
|
| Rate for Payer: Cigna of CA PPO |
$219.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.68
|
| Rate for Payer: InnovAge PACE Commercial |
$148.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Riverside University Health System MISP |
$118.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC SENSURA MIO OSTOMY KIT RED
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT RED
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4414
|
| Hospital Charge Code |
901698857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT YELLOW
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC SENSURA MIO OSTOMY KIT YELLOW
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC SEO SUPINATOR
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT L3974
|
| Hospital Charge Code |
903203974
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
|
HC SEO SUPINATOR
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT L3974
|
| Hospital Charge Code |
903203974
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.71
|
| Rate for Payer: Blue Shield of California Commercial |
$109.98
|
| Rate for Payer: Blue Shield of California EPN |
$71.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$115.20
|
| Rate for Payer: Cigna of CA PPO |
$133.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: InnovAge PACE Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Riverside University Health System MISP |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.00
|
| Rate for Payer: United Healthcare All Other HMO |
$90.00
|
| Rate for Payer: United Healthcare HMO Rider |
$90.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SEP LOWER LIMBS
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
900600223
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,888.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$944.00
|
| Rate for Payer: EPIC Health Plan Senior |
$944.00
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,124.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$899.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,460.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
|
|
HC SEP LOWER LIMBS
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
900600223
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$211.82 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,433.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,386.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,432.52
|
| Rate for Payer: Blue Shield of California EPN |
$936.92
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,888.00
|
| Rate for Payer: Cigna of CA HMO |
$1,510.40
|
| Rate for Payer: Cigna of CA PPO |
$1,746.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,124.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,574.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,770.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,416.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,416.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$460.38 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,536.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,322.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,453.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,535.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,658.27
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: Cigna of CA HMO |
$2,673.28
|
| Rate for Payer: Cigna of CA PPO |
$3,090.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$460.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,506.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,506.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
IP
|
$4,177.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$835.40 |
| Max. Negotiated Rate |
$3,759.30 |
| Rate for Payer: Adventist Health Commercial |
$835.40
|
| Rate for Payer: Cash Price |
$1,879.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,670.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,670.80
|
| Rate for Payer: Galaxy Health WC |
$3,550.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,506.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,759.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,786.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,585.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.40
|
| Rate for Payer: Multiplan Commercial |
$3,132.75
|
| Rate for Payer: Networks By Design Commercial |
$2,715.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,550.45
|
|
|
HC SEP, UPPER LIMBS
|
Facility
|
OP
|
$3,261.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
900600220
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$145.77 |
| Max. Negotiated Rate |
$2,934.90 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,980.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$365.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,979.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,294.62
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,608.80
|
| Rate for Payer: Cigna of CA HMO |
$2,087.04
|
| Rate for Payer: Cigna of CA PPO |
$2,413.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,934.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,175.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$2,445.75
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,956.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC SEP, UPPER LIMBS
|
Facility
|
IP
|
$3,261.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
900600220
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,934.90 |
| Rate for Payer: Adventist Health Commercial |
$652.20
|
| Rate for Payer: Cash Price |
$1,467.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,608.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.40
|
| Rate for Payer: Galaxy Health WC |
$2,771.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,934.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,175.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,242.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,018.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.20
|
| Rate for Payer: Multiplan Commercial |
$2,445.75
|
| Rate for Payer: Networks By Design Commercial |
$2,119.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.85
|
|
|
HC SERVO CONTROL STEEPER OR EQUAL
|
Facility
|
IP
|
$1,457.00
|
|
|
Service Code
|
CPT L7266
|
| Hospital Charge Code |
905357266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,311.30 |
| Rate for Payer: Adventist Health Commercial |
$291.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,126.26
|
| Rate for Payer: Blue Shield of California EPN |
$734.33
|
| Rate for Payer: Cash Price |
$655.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,165.60
|
| Rate for Payer: Cigna of CA HMO |
$1,019.90
|
| Rate for Payer: Cigna of CA PPO |
$1,019.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$582.80
|
| Rate for Payer: Galaxy Health WC |
$1,238.45
|
| Rate for Payer: Global Benefits Group Commercial |
$874.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,311.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$971.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$901.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.40
|
| Rate for Payer: Multiplan Commercial |
$1,092.75
|
| Rate for Payer: Networks By Design Commercial |
$947.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,238.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.81
|
| Rate for Payer: United Healthcare All Other HMO |
$532.24
|
| Rate for Payer: United Healthcare HMO Rider |
$520.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.17
|
|
|
HC SERVO CONTROL STEEPER OR EQUAL
|
Facility
|
OP
|
$1,457.00
|
|
|
Service Code
|
CPT L7266
|
| Hospital Charge Code |
905357266
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.17 |
| Max. Negotiated Rate |
$1,311.30 |
| Rate for Payer: Adventist Health Commercial |
$597.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,238.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$801.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,092.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$855.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,126.26
|
| Rate for Payer: Blue Shield of California EPN |
$734.33
|
| Rate for Payer: Cash Price |
$655.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,165.60
|
| Rate for Payer: Cigna of CA HMO |
$1,019.90
|
| Rate for Payer: Cigna of CA PPO |
$1,019.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,238.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,238.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,238.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$582.80
|
| Rate for Payer: Galaxy Health WC |
$1,238.45
|
| Rate for Payer: Global Benefits Group Commercial |
$874.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,311.30
|
| Rate for Payer: InnovAge PACE Commercial |
$728.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$971.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$555.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$901.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,019.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,019.90
|
| Rate for Payer: Multiplan Commercial |
$1,092.75
|
| Rate for Payer: Networks By Design Commercial |
$728.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,238.45
|
| Rate for Payer: Riverside University Health System MISP |
$582.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$874.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$874.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.81
|
| Rate for Payer: United Healthcare All Other HMO |
$532.24
|
| Rate for Payer: United Healthcare HMO Rider |
$520.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,238.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,238.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,238.45
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.64
|
| Rate for Payer: Blue Shield of California Commercial |
$104.70
|
| Rate for Payer: Blue Shield of California EPN |
$68.37
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Cigna of CA HMO |
$109.67
|
| Rate for Payer: Cigna of CA PPO |
$126.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: InnovAge PACE Commercial |
$85.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.95
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
| Rate for Payer: Riverside University Health System MISP |
$68.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.68
|
| Rate for Payer: United Healthcare All Other HMO |
$85.68
|
| Rate for Payer: United Healthcare HMO Rider |
$85.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.66
|
| Rate for Payer: Vantage Medical Group Senior |
$145.66
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.64
|
| Rate for Payer: Blue Shield of California Commercial |
$104.70
|
| Rate for Payer: Blue Shield of California EPN |
$68.37
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Cigna of CA HMO |
$109.67
|
| Rate for Payer: Cigna of CA PPO |
$126.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: InnovAge PACE Commercial |
$85.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.95
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
| Rate for Payer: Riverside University Health System MISP |
$68.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.68
|
| Rate for Payer: United Healthcare All Other HMO |
$85.68
|
| Rate for Payer: United Healthcare HMO Rider |
$85.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.66
|
| Rate for Payer: Vantage Medical Group Senior |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.64
|
| Rate for Payer: Blue Shield of California Commercial |
$104.70
|
| Rate for Payer: Blue Shield of California EPN |
$68.37
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: Cigna of CA HMO |
$109.67
|
| Rate for Payer: Cigna of CA PPO |
$126.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: InnovAge PACE Commercial |
$85.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.95
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
| Rate for Payer: Riverside University Health System MISP |
$68.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.68
|
| Rate for Payer: United Healthcare All Other HMO |
$85.68
|
| Rate for Payer: United Healthcare HMO Rider |
$85.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.66
|
| Rate for Payer: Vantage Medical Group Senior |
$145.66
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Adventist Health Commercial |
$34.27
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Central Health Plan Commercial |
$137.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.54
|
| Rate for Payer: EPIC Health Plan Senior |
$68.54
|
| Rate for Payer: Galaxy Health WC |
$145.66
|
| Rate for Payer: Global Benefits Group Commercial |
$102.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.27
|
| Rate for Payer: Multiplan Commercial |
$128.52
|
| Rate for Payer: Networks By Design Commercial |
$111.38
|
| Rate for Payer: Prime Health Services Commercial |
$145.66
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
IP
|
$87.55
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Adventist Health Commercial |
$17.51
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.02
|
| Rate for Payer: EPIC Health Plan Senior |
$35.02
|
| Rate for Payer: Galaxy Health WC |
$74.42
|
| Rate for Payer: Global Benefits Group Commercial |
$52.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$65.66
|
| Rate for Payer: Networks By Design Commercial |
$56.91
|
| Rate for Payer: Prime Health Services Commercial |
$74.42
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
OP
|
$87.55
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Adventist Health Commercial |
$17.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.42
|
| Rate for Payer: Blue Shield of California Commercial |
$53.49
|
| Rate for Payer: Blue Shield of California EPN |
$34.93
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Central Health Plan Commercial |
$70.04
|
| Rate for Payer: Cigna of CA HMO |
$56.03
|
| Rate for Payer: Cigna of CA PPO |
$64.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.02
|
| Rate for Payer: EPIC Health Plan Senior |
$35.02
|
| Rate for Payer: Galaxy Health WC |
$74.42
|
| Rate for Payer: Global Benefits Group Commercial |
$52.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.80
|
| Rate for Payer: InnovAge PACE Commercial |
$43.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.28
|
| Rate for Payer: Multiplan Commercial |
$65.66
|
| Rate for Payer: Networks By Design Commercial |
$56.91
|
| Rate for Payer: Prime Health Services Commercial |
$74.42
|
| Rate for Payer: Riverside University Health System MISP |
$35.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.77
|
| Rate for Payer: United Healthcare All Other HMO |
$43.77
|
| Rate for Payer: United Healthcare HMO Rider |
$43.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.42
|
| Rate for Payer: Vantage Medical Group Senior |
$74.42
|
|
|
HC SET DECOMPRESSION 0.035INX480CM
|
Facility
|
IP
|
$529.00
|
|
| Hospital Charge Code |
900100345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC SET DECOMPRESSION 0.035INX480CM
|
Facility
|
OP
|
$529.00
|
|
| Hospital Charge Code |
900100345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$256.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.22
|
| Rate for Payer: Blue Shield of California EPN |
$211.07
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: InnovAge PACE Commercial |
$264.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Riverside University Health System MISP |
$211.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
