|
HC BIOPSY ANORECTAL WALL
|
Facility
|
OP
|
$5,770.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,462.00
|
| 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 |
$2,596.50
|
| Rate for Payer: Cash Price |
$2,596.50
|
| Rate for Payer: Cigna of CA PPO |
$4,269.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Media |
$3,508.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Galaxy Health WC |
$4,904.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,462.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,327.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,753.37
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,753.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,683.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5,683.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,848.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Multiplan Commercial |
$4,616.00
|
| Rate for Payer: Networks By Design Commercial |
$3,750.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,904.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,462.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,209.78
|
| 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 |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.48 |
| Max. Negotiated Rate |
$1,234.20 |
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.80
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.48
|
| Rate for Payer: Multiplan Commercial |
$1,161.60
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$871.20
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cigna of CA PPO |
$1,074.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,089.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,161.60
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$871.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$726.00
|
| Rate for Payer: United Healthcare All Other HMO |
$726.00
|
| Rate for Payer: United Healthcare HMO Rider |
$726.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$726.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC BIOPSY OF CERVIX
|
Facility
|
IP
|
$2,266.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$543.84 |
| Max. Negotiated Rate |
$1,926.10 |
| Rate for Payer: Cash Price |
$1,019.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$906.40
|
| Rate for Payer: Galaxy Health WC |
$1,926.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,359.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,511.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$863.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.84
|
| Rate for Payer: Multiplan Commercial |
$1,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,472.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,926.10
|
|
|
HC BIOPSY OF CERVIX
|
Facility
|
OP
|
$2,266.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,359.60
|
| Rate for Payer: Cash Price |
$1,019.70
|
| Rate for Payer: Cash Price |
$1,019.70
|
| Rate for Payer: Cash Price |
$1,019.70
|
| Rate for Payer: Cigna of CA PPO |
$1,676.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Dignity Health Media |
$1,004.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,004.43
|
| Rate for Payer: Galaxy Health WC |
$1,926.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,359.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,699.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,647.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,647.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,004.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,511.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,004.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.94
|
| Rate for Payer: Multiplan Commercial |
$1,812.80
|
| Rate for Payer: Networks By Design Commercial |
$1,472.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,926.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,359.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,133.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,133.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,133.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
IP
|
$6,507.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,561.68 |
| Max. Negotiated Rate |
$5,530.95 |
| Rate for Payer: Cash Price |
$2,928.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,602.80
|
| Rate for Payer: Galaxy Health WC |
$5,530.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,479.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.68
|
| Rate for Payer: Multiplan Commercial |
$5,205.60
|
| Rate for Payer: Networks By Design Commercial |
$4,229.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,530.95
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
OP
|
$6,507.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.06 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,904.20
|
| 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 |
$2,928.15
|
| Rate for Payer: Cash Price |
$2,928.15
|
| Rate for Payer: Cigna of CA PPO |
$4,815.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$5,530.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,880.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,253.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,253.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$5,205.60
|
| Rate for Payer: Networks By Design Commercial |
$4,229.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,530.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,904.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
OP
|
$2,188.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,312.80
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna of CA PPO |
$1,619.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,859.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,641.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,459.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$1,750.40
|
| Rate for Payer: Networks By Design Commercial |
$1,422.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,859.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,312.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,094.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,094.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,094.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,094.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
IP
|
$2,188.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$525.12 |
| Max. Negotiated Rate |
$1,859.80 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$875.20
|
| Rate for Payer: Galaxy Health WC |
$1,859.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,312.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,459.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$833.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.12
|
| Rate for Payer: Multiplan Commercial |
$1,750.40
|
| Rate for Payer: Networks By Design Commercial |
$1,422.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,859.80
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$702.96 |
| Max. Negotiated Rate |
$2,489.65 |
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,171.60
|
| Rate for Payer: Galaxy Health WC |
$2,489.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,757.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,953.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.96
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: Networks By Design Commercial |
$1,903.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,489.65
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,757.40
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cigna of CA PPO |
$2,167.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$2,489.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,757.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,196.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,953.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: Networks By Design Commercial |
$1,903.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,489.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,757.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,464.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,464.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,464.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,464.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.05
|
| Rate for Payer: Blue Distinction Transplant |
$168.00
|
| Rate for Payer: Blue Shield of California Commercial |
$180.88
|
| Rate for Payer: Blue Shield of California EPN |
$143.36
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Media |
$42.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$69.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BLADDER INSTILL ANTICARCINOGEN
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
911800119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$702.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: Cigna of CA PPO |
$866.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Media |
$853.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$853.50
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$878.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,399.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.69
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.60
|
| 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 |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC BLADDER INSTILL ANTICARCINOGEN
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
911800119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.04 |
| Max. Negotiated Rate |
$995.35 |
| Rate for Payer: Cash Price |
$526.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.40
|
| Rate for Payer: Galaxy Health WC |
$995.35
|
| Rate for Payer: Global Benefits Group Commercial |
$702.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.04
|
| Rate for Payer: Multiplan Commercial |
$936.80
|
| Rate for Payer: Networks By Design Commercial |
$761.15
|
| Rate for Payer: Prime Health Services Commercial |
$995.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$529.20
|
| Rate for Payer: Blue Shield of California Commercial |
$650.03
|
| Rate for Payer: Blue Shield of California EPN |
$515.09
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$661.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$500.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.00
|
| Rate for Payer: United Healthcare All Other HMO |
$441.00
|
| Rate for Payer: United Healthcare HMO Rider |
$441.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$211.68 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$41.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.15
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Media |
$4.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,113.50 |
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$786.00
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna of CA PPO |
$969.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$982.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$1,048.00
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$655.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,527.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$8,049.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,689.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,689.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,116.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cigna of CA PPO |
$6,309.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Dignity Health Media |
$7,247.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,395.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.48
|
| Rate for Payer: Multiplan Commercial |
$6,821.60
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,116.20
|
| 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 |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,247.95
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,527.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,046.48 |
| Max. Negotiated Rate |
$7,247.95 |
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,410.80
|
| Rate for Payer: Galaxy Health WC |
$7,247.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,116.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,687.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.48
|
| Rate for Payer: Multiplan Commercial |
$6,821.60
|
| Rate for Payer: Networks By Design Commercial |
$5,542.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,247.95
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$539.05 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,147.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$22,542.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,269.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,485.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
