|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC ELECT STIMULATION UNATTENDED MCAL
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT G0283
|
| Hospital Charge Code |
901300085
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.68 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$171.00
|
| 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 |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: Dignity Health Media |
$242.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$213.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| 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 |
$242.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$100.30 |
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Media |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| 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 |
$100.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$100.30 |
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Media |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| 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 |
$100.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$75.00
|
| 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 |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Media |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| 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 |
$106.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
IP
|
$5,574.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,337.76 |
| Max. Negotiated Rate |
$4,737.90 |
| Rate for Payer: Cash Price |
$2,508.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,229.60
|
| Rate for Payer: Galaxy Health WC |
$4,737.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,344.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,717.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,123.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,337.76
|
| Rate for Payer: Multiplan Commercial |
$4,459.20
|
| Rate for Payer: Networks By Design Commercial |
$3,623.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,737.90
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
OP
|
$5,574.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$8,628.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,344.40
|
| Rate for Payer: Cash Price |
$2,508.30
|
| Rate for Payer: Cash Price |
$2,508.30
|
| Rate for Payer: Cash Price |
$2,508.30
|
| Rate for Payer: Cigna of CA PPO |
$4,124.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$4,737.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,344.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,180.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| 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 |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,717.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,337.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,459.20
|
| Rate for Payer: Networks By Design Commercial |
$3,623.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,737.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,344.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,787.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,787.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
IP
|
$27,649.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,635.76 |
| Max. Negotiated Rate |
$23,501.65 |
| Rate for Payer: Cash Price |
$12,442.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,059.60
|
| Rate for Payer: Galaxy Health WC |
$23,501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,589.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,441.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,534.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,635.76
|
| Rate for Payer: Multiplan Commercial |
$22,119.20
|
| Rate for Payer: Networks By Design Commercial |
$17,971.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,501.65
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$27,649.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$16,589.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$12,442.05
|
| Rate for Payer: Cash Price |
$12,442.05
|
| Rate for Payer: Cigna of CA PPO |
$20,460.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$23,501.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,589.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20,736.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,441.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,635.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$22,119.20
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$17,971.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,501.65
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,589.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
OP
|
$8,563.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,585.93 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,278.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,709.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,709.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,137.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,853.35
|
| Rate for Payer: Cash Price |
$3,853.35
|
| Rate for Payer: Cigna of CA PPO |
$6,336.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,278.55
|
| Rate for Payer: Dignity Health Media |
$7,278.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,278.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,425.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,425.20
|
| Rate for Payer: Galaxy Health WC |
$7,278.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,137.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,422.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,711.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,585.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.12
|
| Rate for Payer: Multiplan Commercial |
$6,850.40
|
| Rate for Payer: Networks By Design Commercial |
$5,565.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,278.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,137.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,278.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,278.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,278.55
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
IP
|
$8,563.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,055.12 |
| Max. Negotiated Rate |
$7,278.55 |
| Rate for Payer: Cash Price |
$3,853.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,425.20
|
| Rate for Payer: Galaxy Health WC |
$7,278.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,137.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,711.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,262.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,055.12
|
| Rate for Payer: Multiplan Commercial |
$6,850.40
|
| Rate for Payer: Networks By Design Commercial |
$5,565.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,278.55
|
|
|
HC EM EMBED ONLY
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$220.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.19
|
| Rate for Payer: Blue Distinction Transplant |
$201.60
|
| Rate for Payer: Blue Shield of California Commercial |
$217.06
|
| Rate for Payer: Blue Shield of California EPN |
$172.03
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC EM EMBED ONLY
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC END ABL THY INC VEIN 1ST VEIN
|
Facility
|
IP
|
$14,176.00
|
|
|
Service Code
|
CPT 36482
|
| Hospital Charge Code |
909026482
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,402.24 |
| Max. Negotiated Rate |
$12,049.60 |
| Rate for Payer: Cash Price |
$6,379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,670.40
|
| Rate for Payer: Galaxy Health WC |
$12,049.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,505.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,455.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,401.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,402.24
|
| Rate for Payer: Multiplan Commercial |
$11,340.80
|
| Rate for Payer: Networks By Design Commercial |
$9,214.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,049.60
|
|
|
HC END ABL THY INC VEIN 1ST VEIN
|
Facility
|
OP
|
$14,176.00
|
|
|
Service Code
|
CPT 36482
|
| Hospital Charge Code |
909026482
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,402.24 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,505.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$6,379.20
|
| Rate for Payer: Cash Price |
$6,379.20
|
| Rate for Payer: Cigna of CA PPO |
$10,490.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$12,049.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,505.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,632.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,455.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,740.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,402.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$11,340.80
|
| Rate for Payer: Networks By Design Commercial |
$9,214.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,049.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,505.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
OP
|
$4,037.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$913.22 |
| 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 |
$3,431.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,220.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,422.20
|
| 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 |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cigna of CA PPO |
$2,987.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Dignity Health Media |
$3,431.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,431.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,027.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$913.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,422.20
|
| 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 |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,431.45
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
IP
|
$4,037.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$968.88 |
| Max. Negotiated Rate |
$3,431.45 |
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,538.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$2,489.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$597.36 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Cash Price |
$1,120.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$995.60
|
| Rate for Payer: Galaxy Health WC |
$2,115.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,493.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,660.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.36
|
| Rate for Payer: Multiplan Commercial |
$1,991.20
|
| Rate for Payer: Networks By Design Commercial |
$1,617.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,115.65
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$2,489.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$275.86 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,493.40
|
| Rate for Payer: Cash Price |
$1,120.05
|
| Rate for Payer: Cash Price |
$1,120.05
|
| Rate for Payer: Cash Price |
$1,120.05
|
| Rate for Payer: Cigna of CA PPO |
$1,841.86
|
| 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 |
$2,115.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,493.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,866.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,647.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,647.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,004.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,660.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,004.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$597.36
|
| 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 |
$1,991.20
|
| Rate for Payer: Networks By Design Commercial |
$1,617.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,115.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,493.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,244.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,244.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,244.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,244.50
|
| 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 ENDO EVAL SM INTESTINE W BX
|
Facility
|
IP
|
$4,782.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,147.68 |
| Max. Negotiated Rate |
$4,064.70 |
| Rate for Payer: Cash Price |
$2,151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,912.80
|
| Rate for Payer: Galaxy Health WC |
$4,064.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,869.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,189.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,821.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,147.68
|
| Rate for Payer: Multiplan Commercial |
$3,825.60
|
| Rate for Payer: Networks By Design Commercial |
$3,108.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,064.70
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$231.31 |
| 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 |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,456.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cash Price |
$1,092.60
|
| Rate for Payer: Cigna of CA PPO |
$1,796.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$2,063.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,456.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,821.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,872.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,849.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,849.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,619.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,942.40
|
| Rate for Payer: Networks By Design Commercial |
$1,578.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,063.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,456.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,370.32
|
| 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 |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
IP
|
$3,826.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$918.24 |
| Max. Negotiated Rate |
$3,252.10 |
| Rate for Payer: Cash Price |
$1,721.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,530.40
|
| Rate for Payer: Galaxy Health WC |
$3,252.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,295.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,551.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,457.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.24
|
| Rate for Payer: Multiplan Commercial |
$3,060.80
|
| Rate for Payer: Networks By Design Commercial |
$2,486.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,252.10
|
|
