|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,197.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$451.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.48
|
| Rate for Payer: BCBS Transplant Transplant |
$845.40
|
| Rate for Payer: Blue Shield of California Commercial |
$832.72
|
| Rate for Payer: Blue Shield of California EPN |
$660.82
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cigna of CA HMO |
$901.76
|
| Rate for Payer: Cigna of CA PPO |
$1,042.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,056.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$338.16 |
| Max. Negotiated Rate |
$1,197.65 |
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.16
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$338.16 |
| Max. Negotiated Rate |
$1,197.65 |
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.16
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,197.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$451.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.48
|
| Rate for Payer: BCBS Transplant Transplant |
$845.40
|
| Rate for Payer: Blue Shield of California Commercial |
$832.72
|
| Rate for Payer: Blue Shield of California EPN |
$660.82
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cigna of CA HMO |
$901.76
|
| Rate for Payer: Cigna of CA PPO |
$1,042.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,056.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$343.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.96
|
| Rate for Payer: BCBS Transplant Transplant |
$1,205.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.32
|
| Rate for Payer: Blue Shield of California EPN |
$942.22
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA HMO |
$1,285.76
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,506.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$343.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,196.96
|
| Rate for Payer: BCBS Transplant Transplant |
$1,205.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.32
|
| Rate for Payer: Blue Shield of California EPN |
$942.22
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA HMO |
$1,285.76
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,506.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
IP
|
$10,450.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,508.00 |
| Max. Negotiated Rate |
$8,882.50 |
| Rate for Payer: Cash Price |
$4,702.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,180.00
|
| Rate for Payer: Galaxy Health WC |
$8,882.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,970.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,981.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,508.00
|
| Rate for Payer: Multiplan Commercial |
$8,360.00
|
| Rate for Payer: Networks By Design Commercial |
$6,792.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,882.50
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$5,683.20
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$5,683.20
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3,858.96
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$871.20
|
| 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,359.60
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$3,253.11
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,253.11
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3,904.20
|
| 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 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,312.80
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,757.40
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.05
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$210.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$70.26
|
| Rate for Payer: IEHP Medi-Cal |
$69.40
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$69.40
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$168.00
|
| 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
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 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: AlphaCare Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$1,382.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,382.67
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$702.60
|
| 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 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 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: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$661.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: IEHP Medi-Cal |
$500.24
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$500.24
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$529.20
|
| 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
|
|
