|
HC SENSORY TEST ENDOSCOP SWALLOW
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
905601752
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$577.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$577.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$278.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$196.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$278.80
|
| Rate for Payer: Dignity Health Media |
$278.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$278.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.48
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Riverside University Health System MISP |
$131.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$278.80
|
| Rate for Payer: Vantage Medical Group Senior |
$278.80
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
|
|
HC SEO ADD MOB ELEV PROX
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT L3970
|
| Hospital Charge Code |
901309115
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Central Health Plan Commercial |
$499.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$561.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$416.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
|
|
HC SEO ADD MOB ELEV PROX
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT L3970
|
| Hospital Charge Code |
901309115
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$378.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$530.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$302.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.66
|
| Rate for Payer: Blue Distinction Transplant |
$374.40
|
| Rate for Payer: Blue Shield of California Commercial |
$392.50
|
| Rate for Payer: Blue Shield of California EPN |
$305.14
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Central Health Plan Commercial |
$499.20
|
| Rate for Payer: Cigna of CA HMO |
$399.36
|
| Rate for Payer: Cigna of CA PPO |
$461.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$530.40
|
| Rate for Payer: Dignity Health Media |
$530.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$561.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$468.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$218.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$416.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
| Rate for Payer: Riverside University Health System MISP |
$249.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$374.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$374.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Other HMO |
$312.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$312.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$530.40
|
| Rate for Payer: Vantage Medical Group Senior |
$530.40
|
|
|
HC SEO ADD MOB ROCKER ARM W/BAL C
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT L3972
|
| Hospital Charge Code |
901309116
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Central Health Plan Commercial |
$443.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$498.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.80
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
|
|
HC SEO ADD MOB ROCKER ARM W/BAL C
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT L3972
|
| Hospital Charge Code |
901309116
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$336.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.30
|
| Rate for Payer: Blue Distinction Transplant |
$332.40
|
| Rate for Payer: Blue Shield of California Commercial |
$348.47
|
| Rate for Payer: Blue Shield of California EPN |
$270.91
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Central Health Plan Commercial |
$443.20
|
| Rate for Payer: Cigna of CA HMO |
$354.56
|
| Rate for Payer: Cigna of CA PPO |
$409.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Media |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$498.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$415.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$193.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.80
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
| Rate for Payer: Riverside University Health System MISP |
$221.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$332.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$332.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$277.00
|
| Rate for Payer: United Healthcare All Other HMO |
$277.00
|
| Rate for Payer: United Healthcare HMO Rider |
$277.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC SEO SUPINATOR
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3974
|
| Hospital Charge Code |
903203974
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC SEO SUPINATOR
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3974
|
| Hospital Charge Code |
903203974
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.25
|
| Rate for Payer: Blue Distinction Transplant |
$127.20
|
| Rate for Payer: Blue Shield of California Commercial |
$133.35
|
| Rate for Payer: Blue Shield of California EPN |
$103.67
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$135.68
|
| Rate for Payer: Cigna of CA PPO |
$156.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Media |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.00
|
| Rate for Payer: United Healthcare All Other HMO |
$106.00
|
| Rate for Payer: United Healthcare HMO Rider |
$106.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC SEP LOWER LIMBS
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
900600223
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$1,292.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
|
|
HC SEP LOWER LIMBS
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
900600223
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$233.98 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$755.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.51
|
| Rate for Payer: Blue Distinction Transplant |
$1,192.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,228.58
|
| Rate for Payer: Blue Shield of California EPN |
$966.17
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,272.32
|
| Rate for Payer: Cigna of CA PPO |
$1,471.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,491.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$1,292.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
OP
|
$3,518.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$508.57 |
| Max. Negotiated Rate |
$3,166.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,541.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,322.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,078.43
|
| Rate for Payer: Blue Distinction Transplant |
$2,110.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,174.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,709.75
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,814.40
|
| Rate for Payer: Cigna of CA HMO |
$2,251.52
|
| Rate for Payer: Cigna of CA PPO |
$2,603.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$2,990.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,110.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,166.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,638.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,346.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$2,638.50
|
| Rate for Payer: Networks By Design Commercial |
$2,286.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,990.30
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,110.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
IP
|
$3,518.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$703.60 |
| Max. Negotiated Rate |
$3,166.20 |
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,814.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,407.20
|
| Rate for Payer: Galaxy Health WC |
$2,990.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,110.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,166.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,346.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,340.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.60
|
| Rate for Payer: Multiplan Commercial |
$2,638.50
|
| Rate for Payer: Networks By Design Commercial |
$2,286.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,990.30
|
|
|
HC SEP, UPPER LIMBS
|
Facility
|
OP
|
$2,747.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
900600220
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$161.02 |
| Max. Negotiated Rate |
$2,472.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$788.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$365.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,622.93
|
| Rate for Payer: Blue Distinction Transplant |
$1,648.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,697.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.04
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$1,236.15
|
| Rate for Payer: Cash Price |
$1,236.15
|
| Rate for Payer: Cash Price |
$1,236.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,197.60
|
| Rate for Payer: Cigna of CA HMO |
$1,758.08
|
| Rate for Payer: Cigna of CA PPO |
$2,032.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$2,334.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,472.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,060.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$2,060.25
|
| Rate for Payer: Networks By Design Commercial |
$1,785.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.95
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,648.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,648.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC SEP, UPPER LIMBS
|
Facility
|
IP
|
$2,747.00
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
900600220
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$549.40 |
| Max. Negotiated Rate |
$2,472.30 |
| Rate for Payer: Cash Price |
$1,236.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,197.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,098.80
|
| Rate for Payer: Galaxy Health WC |
$2,334.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,648.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,472.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.40
|
| Rate for Payer: Multiplan Commercial |
$2,060.25
|
| Rate for Payer: Networks By Design Commercial |
$1,785.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.95
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
IP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$768.30 |
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Central Health Plan Commercial |
$682.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.73
|
| Rate for Payer: Multiplan Commercial |
$640.25
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
|
|
HC SET CATH ARTERIAL 22GA X 5CM
|
Facility
|
OP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$469.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$413.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.35
|
| Rate for Payer: Blue Distinction Transplant |
$512.20
|
| Rate for Payer: Blue Shield of California Commercial |
$536.96
|
| Rate for Payer: Blue Shield of California EPN |
$417.44
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Central Health Plan Commercial |
$682.94
|
| Rate for Payer: Cigna of CA HMO |
$546.35
|
| Rate for Payer: Cigna of CA PPO |
$631.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.62
|
| Rate for Payer: Dignity Health Media |
$725.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$640.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$298.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.73
|
| Rate for Payer: Multiplan Commercial |
$640.25
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
| Rate for Payer: Riverside University Health System MISP |
$341.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.84
|
| Rate for Payer: United Healthcare All Other HMO |
$426.84
|
| Rate for Payer: United Healthcare HMO Rider |
$426.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.62
|
| Rate for Payer: Vantage Medical Group Senior |
$725.62
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
IP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$768.30 |
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Central Health Plan Commercial |
$682.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.73
|
| Rate for Payer: Multiplan Commercial |
$640.25
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
|
|
HC SET CATH ARTERIAL 24GA X 2.5CM
|
Facility
|
OP
|
$853.67
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$469.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$413.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.35
|
| Rate for Payer: Blue Distinction Transplant |
$512.20
|
| Rate for Payer: Blue Shield of California Commercial |
$536.96
|
| Rate for Payer: Blue Shield of California EPN |
$417.44
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Central Health Plan Commercial |
$682.94
|
| Rate for Payer: Cigna of CA HMO |
$546.35
|
| Rate for Payer: Cigna of CA PPO |
$631.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.62
|
| Rate for Payer: Dignity Health Media |
$725.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$341.47
|
| Rate for Payer: Galaxy Health WC |
$725.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$640.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$298.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$569.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.73
|
| Rate for Payer: Multiplan Commercial |
$640.25
|
| Rate for Payer: Networks By Design Commercial |
$554.89
|
| Rate for Payer: Prime Health Services Commercial |
$725.62
|
| Rate for Payer: Riverside University Health System MISP |
$341.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$426.84
|
| Rate for Payer: United Healthcare All Other HMO |
$426.84
|
| Rate for Payer: United Healthcare HMO Rider |
$426.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$426.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.62
|
| Rate for Payer: Vantage Medical Group Senior |
$725.62
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
IP
|
$136.65
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$122.98 |
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Central Health Plan Commercial |
$109.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.66
|
| Rate for Payer: Galaxy Health WC |
$116.15
|
| Rate for Payer: Global Benefits Group Commercial |
$81.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.33
|
| Rate for Payer: Multiplan Commercial |
$102.49
|
| Rate for Payer: Networks By Design Commercial |
$88.82
|
| Rate for Payer: Prime Health Services Commercial |
$116.15
|
|
|
HC SET CATH ARTERIAL 24GA X 5CM
|
Facility
|
OP
|
$136.65
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.73
|
| Rate for Payer: Blue Distinction Transplant |
$81.99
|
| Rate for Payer: Blue Shield of California Commercial |
$85.95
|
| Rate for Payer: Blue Shield of California EPN |
$66.82
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Central Health Plan Commercial |
$109.32
|
| Rate for Payer: Cigna of CA HMO |
$87.46
|
| Rate for Payer: Cigna of CA PPO |
$101.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.15
|
| Rate for Payer: Dignity Health Media |
$116.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.66
|
| Rate for Payer: Galaxy Health WC |
$116.15
|
| Rate for Payer: Global Benefits Group Commercial |
$81.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$102.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.33
|
| Rate for Payer: Multiplan Commercial |
$102.49
|
| Rate for Payer: Networks By Design Commercial |
$88.82
|
| Rate for Payer: Prime Health Services Commercial |
$116.15
|
| Rate for Payer: Riverside University Health System MISP |
$54.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.32
|
| Rate for Payer: United Healthcare All Other HMO |
$68.32
|
| Rate for Payer: United Healthcare HMO Rider |
$68.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.15
|
| Rate for Payer: Vantage Medical Group Senior |
$116.15
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
IP
|
$79.79
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$71.81 |
| Rate for Payer: Cash Price |
$35.91
|
| Rate for Payer: Central Health Plan Commercial |
$63.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.92
|
| Rate for Payer: Galaxy Health WC |
$67.82
|
| Rate for Payer: Global Benefits Group Commercial |
$47.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$59.84
|
| Rate for Payer: Networks By Design Commercial |
$51.86
|
| Rate for Payer: Prime Health Services Commercial |
$67.82
|
|
|
HC SET CATH RADIAL ARTRY 22GA
|
Facility
|
OP
|
$79.79
|
|
| Hospital Charge Code |
901602677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$71.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.14
|
| Rate for Payer: Blue Distinction Transplant |
$47.87
|
| Rate for Payer: Blue Shield of California Commercial |
$50.19
|
| Rate for Payer: Blue Shield of California EPN |
$39.02
|
| Rate for Payer: Cash Price |
$35.91
|
| Rate for Payer: Central Health Plan Commercial |
$63.83
|
| Rate for Payer: Cigna of CA HMO |
$51.07
|
| Rate for Payer: Cigna of CA PPO |
$59.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.82
|
| Rate for Payer: Dignity Health Media |
$67.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.92
|
| Rate for Payer: Galaxy Health WC |
$67.82
|
| Rate for Payer: Global Benefits Group Commercial |
$47.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$59.84
|
| Rate for Payer: Networks By Design Commercial |
$51.86
|
| Rate for Payer: Prime Health Services Commercial |
$67.82
|
| Rate for Payer: Riverside University Health System MISP |
$31.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.90
|
| Rate for Payer: United Healthcare All Other HMO |
$39.90
|
| Rate for Payer: United Healthcare HMO Rider |
$39.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.82
|
| Rate for Payer: Vantage Medical Group Senior |
$67.82
|
|
|
HC SET DIALYNATE PERITONEAL
|
Facility
|
IP
|
$573.62
|
|
| Hospital Charge Code |
901605981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$516.26 |
| Rate for Payer: Cash Price |
$258.13
|
| Rate for Payer: Central Health Plan Commercial |
$458.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$430.22
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
|
|
HC SET DIALYNATE PERITONEAL
|
Facility
|
OP
|
$573.62
|
|
| Hospital Charge Code |
901605981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$516.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$348.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.89
|
| Rate for Payer: Blue Distinction Transplant |
$344.17
|
| Rate for Payer: Blue Shield of California Commercial |
$360.81
|
| Rate for Payer: Blue Shield of California EPN |
$280.50
|
| Rate for Payer: Cash Price |
$258.13
|
| Rate for Payer: Central Health Plan Commercial |
$458.90
|
| Rate for Payer: Cigna of CA HMO |
$367.12
|
| Rate for Payer: Cigna of CA PPO |
$424.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.58
|
| Rate for Payer: Dignity Health Media |
$487.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$430.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$430.22
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
| Rate for Payer: Riverside University Health System MISP |
$229.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.81
|
| Rate for Payer: United Healthcare All Other HMO |
$286.81
|
| Rate for Payer: United Healthcare HMO Rider |
$286.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.58
|
| Rate for Payer: Vantage Medical Group Senior |
$487.58
|
|
