|
HC CERVICAL CAP REMOVAL
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.38
|
| Rate for Payer: Blue Distinction Transplant |
$231.00
|
| Rate for Payer: Blue Shield of California Commercial |
$283.74
|
| Rate for Payer: Blue Shield of California EPN |
$224.84
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$288.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$408.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$403.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$403.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.12 |
| 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 |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$982.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,207.21
|
| Rate for Payer: Blue Shield of California EPN |
$956.59
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cigna of CA HMO |
$1,048.32
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$819.00
|
| Rate for Payer: United Healthcare All Other HMO |
$819.00
|
| Rate for Payer: United Healthcare HMO Rider |
$819.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$393.12 |
| 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 |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$982.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,207.21
|
| Rate for Payer: Blue Shield of California EPN |
$956.59
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cigna of CA HMO |
$1,048.32
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$530.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$374.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna of CA PPO |
$461.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$530.40
|
| Rate for Payer: Dignity Health Media |
$530.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$416.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$374.40
|
| 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 |
$530.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$530.40
|
| Rate for Payer: Vantage Medical Group Senior |
$530.40
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$416.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
OP
|
$6,880.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,128.00
|
| 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 |
$3,096.00
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Cigna of CA PPO |
$5,091.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$5,848.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,128.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,588.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: Networks By Design Commercial |
$4,472.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,848.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,128.00
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
IP
|
$6,880.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,651.20 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,752.00
|
| Rate for Payer: Galaxy Health WC |
$5,848.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,128.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,588.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,621.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.20
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: Networks By Design Commercial |
$4,472.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,848.00
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.64 |
| Max. Negotiated Rate |
$1,326.85 |
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.40
|
| Rate for Payer: Galaxy Health WC |
$1,326.85
|
| Rate for Payer: Global Benefits Group Commercial |
$936.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.64
|
| Rate for Payer: Multiplan Commercial |
$1,248.80
|
| Rate for Payer: Networks By Design Commercial |
$1,014.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,326.85
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.79 |
| 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 |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$936.60
|
| 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 |
$702.45
|
| Rate for Payer: Cash Price |
$702.45
|
| Rate for Payer: Cigna of CA PPO |
$1,155.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,326.85
|
| Rate for Payer: Global Benefits Group Commercial |
$936.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,170.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,041.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,248.80
|
| Rate for Payer: Networks By Design Commercial |
$1,014.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,326.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$936.60
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.36 |
| Max. Negotiated Rate |
$1,031.90 |
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.50 |
| 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 |
$1,031.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$667.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$667.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$728.40
|
| 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 |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna of CA PPO |
$898.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.90
|
| Rate for Payer: Dignity Health Media |
$1,031.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$910.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$728.40
|
| 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 |
$1,031.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,031.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,031.90
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
OP
|
$6,495.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$858.04 |
| 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 |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,897.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: Cigna of CA PPO |
$4,806.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$5,520.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,897.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,871.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,332.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$5,196.00
|
| Rate for Payer: Networks By Design Commercial |
$4,221.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,520.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,897.00
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
IP
|
$6,495.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,558.80 |
| Max. Negotiated Rate |
$5,520.75 |
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,598.00
|
| Rate for Payer: Galaxy Health WC |
$5,520.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,897.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,332.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,474.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.80
|
| Rate for Payer: Multiplan Commercial |
$5,196.00
|
| Rate for Payer: Networks By Design Commercial |
$4,221.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,520.75
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
IP
|
$4,590.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$3,901.50 |
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,836.00
|
| Rate for Payer: Galaxy Health WC |
$3,901.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,061.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.60
|
| Rate for Payer: Multiplan Commercial |
$3,672.00
|
| Rate for Payer: Networks By Design Commercial |
$2,983.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,901.50
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
OP
|
$4,590.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,101.60 |
| 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 |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,754.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cigna of CA PPO |
$3,396.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,901.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,442.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,061.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,672.00
|
| Rate for Payer: Networks By Design Commercial |
$2,983.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,901.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,754.00
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
OP
|
$5,698.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.60 |
| 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 |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,418.80
|
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: Cigna of CA PPO |
$4,216.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$4,843.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,418.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,273.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| 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 |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,800.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,367.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$4,558.40
|
| Rate for Payer: Networks By Design Commercial |
$3,703.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,843.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,849.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,849.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,849.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
IP
|
$5,698.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,367.52 |
| Max. Negotiated Rate |
$4,843.30 |
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,279.20
|
| Rate for Payer: Galaxy Health WC |
$4,843.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,800.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,170.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,367.52
|
| Rate for Payer: Multiplan Commercial |
$4,558.40
|
| Rate for Payer: Networks By Design Commercial |
$3,703.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,843.30
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
IP
|
$9,772.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,345.28 |
| Max. Negotiated Rate |
$8,306.20 |
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,908.80
|
| Rate for Payer: Galaxy Health WC |
$8,306.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,863.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,517.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,723.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,345.28
|
| Rate for Payer: Multiplan Commercial |
$7,817.60
|
| Rate for Payer: Networks By Design Commercial |
$6,351.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,306.20
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
OP
|
$9,772.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,345.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,863.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: Cigna of CA PPO |
$7,231.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$8,306.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,863.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,329.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,517.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,589.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,345.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$7,817.60
|
| Rate for Payer: Networks By Design Commercial |
$6,351.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,306.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,863.20
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$331.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$168.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$179.84
|
| Rate for Payer: Cigna of CA PPO |
$207.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Media |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
|
