|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
OP
|
$1,803.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$111.28 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,081.80
|
| 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 |
$811.35
|
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: Cigna of CA PPO |
$1,334.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,532.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,081.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,352.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$1,834.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,202.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,171.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,532.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,081.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
IP
|
$1,803.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$432.72 |
| Max. Negotiated Rate |
$1,532.55 |
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$721.20
|
| Rate for Payer: Galaxy Health WC |
$1,532.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,081.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,202.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$686.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.72
|
| Rate for Payer: Multiplan Commercial |
$1,442.40
|
| Rate for Payer: Networks By Design Commercial |
$1,171.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,532.55
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
OP
|
$2,251.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.51 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,913.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,238.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,238.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,350.60
|
| 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 |
$1,012.95
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cigna of CA PPO |
$1,665.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,913.35
|
| Rate for Payer: Dignity Health Media |
$1,913.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,913.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$900.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$900.40
|
| Rate for Payer: Galaxy Health WC |
$1,913.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,350.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,688.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,501.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.24
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: Networks By Design Commercial |
$1,463.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,913.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,350.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,350.60
|
| 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 |
$1,913.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,913.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,913.35
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
IP
|
$2,251.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$540.24 |
| Max. Negotiated Rate |
$1,913.35 |
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$900.40
|
| Rate for Payer: Galaxy Health WC |
$1,913.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,350.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,501.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.24
|
| Rate for Payer: Multiplan Commercial |
$1,800.80
|
| Rate for Payer: Networks By Design Commercial |
$1,463.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,913.35
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
OP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$442.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$483.00
|
| 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 |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Media |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$603.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| 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 |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
IP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
OP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$442.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$483.00
|
| 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 |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Media |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$603.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| 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 |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
IP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
IP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
OP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$365.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$399.00
|
| 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 |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Media |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$498.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$399.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| 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 |
$565.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$2,319.65 |
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,319.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,500.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,500.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,637.40
|
| 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 |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA PPO |
$2,019.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Dignity Health Media |
$2,319.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,319.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,046.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,637.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,637.40
|
| 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 |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,319.65
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
OP
|
$4,493.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,695.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cigna of CA PPO |
$3,324.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,369.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: IEHP Medi-Cal |
$3,908.06
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,695.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,695.80
|
| 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 |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
IP
|
$4,493.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,078.32 |
| Max. Negotiated Rate |
$3,819.05 |
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,797.20
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,711.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
OP
|
$18,438.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,052.56 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: BCBS Transplant Transplant |
$11,062.80
|
| 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 |
$8,297.10
|
| Rate for Payer: Cash Price |
$8,297.10
|
| Rate for Payer: Cigna of CA PPO |
$13,644.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$15,672.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,062.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,828.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: IEHP Medi-Cal |
$11,678.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,298.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,052.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,425.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$14,750.40
|
| Rate for Payer: Networks By Design Commercial |
$11,984.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,672.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11,062.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,062.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
IP
|
$18,438.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,425.12 |
| Max. Negotiated Rate |
$15,672.30 |
| Rate for Payer: Cash Price |
$8,297.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,375.20
|
| Rate for Payer: Galaxy Health WC |
$15,672.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,062.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,298.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,024.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,425.12
|
| Rate for Payer: Multiplan Commercial |
$14,750.40
|
| Rate for Payer: Networks By Design Commercial |
$11,984.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,672.30
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$276.48 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: Galaxy Health WC |
$979.20
|
| Rate for Payer: Global Benefits Group Commercial |
$691.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.48
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: Networks By Design Commercial |
$748.80
|
| Rate for Payer: Prime Health Services Commercial |
$979.20
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$276.48 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$979.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$633.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$633.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$691.20
|
| 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 |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$852.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$979.20
|
| Rate for Payer: Dignity Health Media |
$979.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$979.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$460.80
|
| Rate for Payer: Galaxy Health WC |
$979.20
|
| Rate for Payer: Global Benefits Group Commercial |
$691.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.48
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: Networks By Design Commercial |
$748.80
|
| Rate for Payer: Prime Health Services Commercial |
$979.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$691.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.20
|
| 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 |
$979.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$979.20
|
| Rate for Payer: Vantage Medical Group Senior |
$979.20
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
IP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,021.92 |
| Max. Negotiated Rate |
$14,244.30 |
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,703.20
|
| Rate for Payer: Galaxy Health WC |
$14,244.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,054.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,177.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,384.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,021.92
|
| Rate for Payer: Multiplan Commercial |
$13,406.40
|
| Rate for Payer: Networks By Design Commercial |
$10,892.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,244.30
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
OP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$626.62 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,244.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,216.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,216.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,054.80
|
| 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 |
$7,541.10
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Cigna of CA PPO |
$12,400.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,244.30
|
| Rate for Payer: Dignity Health Media |
$14,244.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,703.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,703.20
|
| Rate for Payer: Galaxy Health WC |
$14,244.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,054.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,568.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,177.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,021.92
|
| Rate for Payer: Multiplan Commercial |
$13,406.40
|
| Rate for Payer: Networks By Design Commercial |
$10,892.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,244.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,054.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,054.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,054.80
|
| 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 |
$14,244.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,244.30
|
| Rate for Payer: Vantage Medical Group Senior |
$14,244.30
|
|
|
HC ABLATION SPINE OTHER
|
Facility
IP
|
$706.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
|
|
HC ABLATION SPINE OTHER
|
Facility
OP
|
$706.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.63
|
| Rate for Payer: BCBS Transplant Transplant |
$423.60
|
| 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 |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA PPO |
$522.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$529.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$477.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$477.32
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$423.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| 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 |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
IP
|
$4,493.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,078.32 |
| Max. Negotiated Rate |
$3,819.05 |
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,797.20
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,711.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
OP
|
$4,493.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.15 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,695.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cigna of CA PPO |
$3,324.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,369.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: IEHP Medi-Cal |
$3,908.06
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,695.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,695.80
|
| 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 |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
IP
|
$27,474.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,593.76 |
| Max. Negotiated Rate |
$23,352.90 |
| Rate for Payer: Cash Price |
$12,363.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,989.60
|
| Rate for Payer: Galaxy Health WC |
$23,352.90
|
| Rate for Payer: Global Benefits Group Commercial |
$16,484.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,325.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,467.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,593.76
|
| Rate for Payer: Multiplan Commercial |
$21,979.20
|
| Rate for Payer: Networks By Design Commercial |
$17,858.10
|
| Rate for Payer: Prime Health Services Commercial |
$23,352.90
|
|
