|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
OP
|
$8,198.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,428.90 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,918.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$3,689.10
|
| Rate for Payer: Cash Price |
$3,689.10
|
| Rate for Payer: Cigna of CA PPO |
$6,066.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$6,968.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,918.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,428.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$6,558.40
|
| Rate for Payer: Networks By Design Commercial |
$5,328.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,968.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,918.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
IP
|
$8,198.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,967.52 |
| Max. Negotiated Rate |
$6,968.30 |
| Rate for Payer: Cash Price |
$3,689.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,279.20
|
| Rate for Payer: Galaxy Health WC |
$6,968.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,918.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,123.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.52
|
| Rate for Payer: Multiplan Commercial |
$6,558.40
|
| Rate for Payer: Networks By Design Commercial |
$5,328.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,968.30
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
OP
|
$21,061.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,686.96 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,636.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cigna of CA PPO |
$15,585.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$17,901.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12,636.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15,795.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,678.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,960.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,054.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$16,848.80
|
| Rate for Payer: Networks By Design Commercial |
$13,689.65
|
| Rate for Payer: Prime Health Services Commercial |
$17,901.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,636.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
IP
|
$21,061.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,054.64 |
| Max. Negotiated Rate |
$17,901.85 |
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,424.40
|
| Rate for Payer: Galaxy Health WC |
$17,901.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12,636.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,024.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,054.64
|
| Rate for Payer: Multiplan Commercial |
$16,848.80
|
| Rate for Payer: Networks By Design Commercial |
$13,689.65
|
| Rate for Payer: Prime Health Services Commercial |
$17,901.85
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
IP
|
$12,630.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,031.20 |
| Max. Negotiated Rate |
$10,735.50 |
| Rate for Payer: Cash Price |
$5,683.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,052.00
|
| Rate for Payer: Galaxy Health WC |
$10,735.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,578.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,812.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,031.20
|
| Rate for Payer: Multiplan Commercial |
$10,104.00
|
| Rate for Payer: Networks By Design Commercial |
$8,209.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,735.50
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
OP
|
$12,630.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$10,735.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,946.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,946.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,578.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$5,683.50
|
| Rate for Payer: Cash Price |
$5,683.50
|
| Rate for Payer: Cigna of CA PPO |
$9,346.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.50
|
| Rate for Payer: Dignity Health Media |
$10,735.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,052.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,052.00
|
| Rate for Payer: Galaxy Health WC |
$10,735.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,578.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,031.20
|
| Rate for Payer: Multiplan Commercial |
$10,104.00
|
| Rate for Payer: Networks By Design Commercial |
$8,209.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,735.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,578.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,735.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,735.50
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
OP
|
$6,023.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,950.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.50
|
| Rate for Payer: Blue Distinction Transplant |
$3,613.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,710.35
|
| Rate for Payer: Cash Price |
$2,710.35
|
| Rate for Payer: Cigna of CA PPO |
$4,457.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$5,119.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,613.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,517.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,017.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,445.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,818.40
|
| Rate for Payer: Networks By Design Commercial |
$3,914.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,119.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,613.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
IP
|
$7,512.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,802.88 |
| Max. Negotiated Rate |
$6,385.20 |
| Rate for Payer: Cash Price |
$3,380.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,004.80
|
| Rate for Payer: Galaxy Health WC |
$6,385.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,507.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,862.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.88
|
| Rate for Payer: Multiplan Commercial |
$6,009.60
|
| Rate for Payer: Networks By Design Commercial |
$4,882.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,385.20
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
OP
|
$7,607.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,423.23 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,564.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$3,423.15
|
| Rate for Payer: Cash Price |
$3,423.15
|
| Rate for Payer: Cigna of CA PPO |
$5,629.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$6,465.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,564.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,705.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,423.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,825.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$6,085.60
|
| Rate for Payer: Networks By Design Commercial |
$4,944.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,465.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,564.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
IP
|
$7,607.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,825.68 |
| Max. Negotiated Rate |
$6,465.95 |
| Rate for Payer: Cash Price |
$3,423.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,042.80
|
| Rate for Payer: Galaxy Health WC |
$6,465.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,564.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,898.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,825.68
|
| Rate for Payer: Multiplan Commercial |
$6,085.60
|
| Rate for Payer: Networks By Design Commercial |
$4,944.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,465.95
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
OP
|
$2,587.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.12 |
| Max. Negotiated Rate |
$2,198.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$521.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,198.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,422.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,422.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,584.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,552.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,528.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,213.30
|
| Rate for Payer: Cash Price |
$1,164.15
|
| Rate for Payer: Cash Price |
$1,164.15
|
| Rate for Payer: Cigna of CA HMO |
$1,655.68
|
| Rate for Payer: Cigna of CA PPO |
$1,914.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,198.95
|
| Rate for Payer: Dignity Health Media |
$2,198.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,198.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,034.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,034.80
|
| Rate for Payer: Galaxy Health WC |
$2,198.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,940.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,725.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.88
|
| Rate for Payer: Multiplan Commercial |
$2,069.60
|
| Rate for Payer: Networks By Design Commercial |
$1,681.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,198.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,552.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,552.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,293.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,293.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,293.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,293.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,198.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,198.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,198.95
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
IP
|
$2,587.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$2,198.95 |
| Rate for Payer: Cash Price |
$1,164.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,034.80
|
| Rate for Payer: Galaxy Health WC |
$2,198.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,552.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,725.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$985.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.88
|
| Rate for Payer: Multiplan Commercial |
$2,069.60
|
| Rate for Payer: Networks By Design Commercial |
$1,681.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,198.95
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.64
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Media |
$5.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.68
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$5.12
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Media |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.64
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Media |
$5.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$45.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.70
|
| Rate for Payer: Blue Distinction Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12.27
|
| Rate for Payer: Blue Shield of California EPN |
$9.73
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Media |
$5.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
OP
|
$17,398.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,686.96 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,438.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$7,829.10
|
| Rate for Payer: Cash Price |
$7,829.10
|
| Rate for Payer: Cigna of CA PPO |
$12,874.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$14,788.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,438.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,048.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,678.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,604.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,018.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,175.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$13,918.40
|
| Rate for Payer: Networks By Design Commercial |
$11,308.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,788.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,438.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
IP
|
$17,398.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,175.52 |
| Max. Negotiated Rate |
$14,788.30 |
| Rate for Payer: Cash Price |
$7,829.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,959.20
|
| Rate for Payer: Galaxy Health WC |
$14,788.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,438.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,604.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,628.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,175.52
|
| Rate for Payer: Multiplan Commercial |
$13,918.40
|
| Rate for Payer: Networks By Design Commercial |
$11,308.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,788.30
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
OP
|
$17,398.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,686.96 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,438.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$7,829.10
|
| Rate for Payer: Cash Price |
$7,829.10
|
| Rate for Payer: Cigna of CA PPO |
$12,874.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$14,788.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,438.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,048.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,678.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,604.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,684.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,175.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$13,918.40
|
| Rate for Payer: Networks By Design Commercial |
$11,308.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,788.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,438.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
IP
|
$17,398.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,175.52 |
| Max. Negotiated Rate |
$14,788.30 |
| Rate for Payer: Cash Price |
$7,829.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,959.20
|
| Rate for Payer: Galaxy Health WC |
$14,788.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,438.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,604.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,628.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,175.52
|
| Rate for Payer: Multiplan Commercial |
$13,918.40
|
| Rate for Payer: Networks By Design Commercial |
$11,308.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,788.30
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$300.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$118.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.69
|
| Rate for Payer: Blue Distinction Transplant |
$129.60
|
| Rate for Payer: Blue Shield of California Commercial |
$159.19
|
| Rate for Payer: Blue Shield of California EPN |
$126.14
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna of CA HMO |
$138.24
|
| Rate for Payer: Cigna of CA PPO |
$159.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Media |
$183.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$1,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.83
|
| Rate for Payer: Blue Distinction Transplant |
$52.20
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Blue Shield of California EPN |
$50.81
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Media |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$65.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
|
IP
|
$10,450.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,508.00 |
| Max. Negotiated Rate |
$8,882.50 |
| Rate for Payer: Cash Price |
$4,702.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,180.00
|
| Rate for Payer: Galaxy Health WC |
$8,882.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,970.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,981.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,508.00
|
| Rate for Payer: Multiplan Commercial |
$8,360.00
|
| Rate for Payer: Networks By Design Commercial |
$6,792.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,882.50
|
|
