|
HC CHANGE EXT/INT URETER STENT
|
Facility
OP
|
$6,495.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$858.04 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,897.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: Cash Price |
$2,922.75
|
| Rate for Payer: Cigna of CA PPO |
$4,806.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$5,520.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,897.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,871.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: IEHP Medi-Cal |
$4,122.69
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,332.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,558.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$5,196.00
|
| Rate for Payer: Networks By Design Commercial |
$4,221.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,520.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,897.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,897.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
IP
|
$4,590.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$3,901.50 |
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,836.00
|
| Rate for Payer: Galaxy Health WC |
$3,901.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,061.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.60
|
| Rate for Payer: Multiplan Commercial |
$3,672.00
|
| Rate for Payer: Networks By Design Commercial |
$2,983.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,901.50
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
OP
|
$4,590.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,754.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cigna of CA PPO |
$3,396.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,901.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,442.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,061.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,672.00
|
| Rate for Payer: Networks By Design Commercial |
$2,983.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,901.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,754.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,754.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
OP
|
$5,698.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,418.80
|
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: Cigna of CA PPO |
$4,216.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$4,843.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,418.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,273.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,800.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,367.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$4,558.40
|
| Rate for Payer: Networks By Design Commercial |
$3,703.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,843.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,418.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,849.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,849.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,849.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
IP
|
$5,698.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,367.52 |
| Max. Negotiated Rate |
$4,843.30 |
| Rate for Payer: Cash Price |
$2,564.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,279.20
|
| Rate for Payer: Galaxy Health WC |
$4,843.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,800.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,170.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,367.52
|
| Rate for Payer: Multiplan Commercial |
$4,558.40
|
| Rate for Payer: Networks By Design Commercial |
$3,703.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,843.30
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
OP
|
$9,772.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,345.28 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,863.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: Cigna of CA PPO |
$7,231.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$8,306.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,863.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,329.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: IEHP Medi-Cal |
$4,122.69
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,517.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,589.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,345.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$7,817.60
|
| Rate for Payer: Networks By Design Commercial |
$6,351.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,306.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,863.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,863.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
IP
|
$9,772.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,345.28 |
| Max. Negotiated Rate |
$8,306.20 |
| Rate for Payer: Cash Price |
$4,397.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,908.80
|
| Rate for Payer: Galaxy Health WC |
$8,306.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,863.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,517.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,723.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,345.28
|
| Rate for Payer: Multiplan Commercial |
$7,817.60
|
| Rate for Payer: Networks By Design Commercial |
$6,351.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,306.20
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
IP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
OP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$331.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$168.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$179.84
|
| Rate for Payer: Cigna of CA PPO |
$207.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Media |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
OP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$331.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$154.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$168.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$179.84
|
| Rate for Payer: Cigna of CA PPO |
$207.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Media |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$210.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
IP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$1,252.90 |
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.60
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$1,252.90 |
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.60
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.19 |
| 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 |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$884.40
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$884.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$737.00
|
| Rate for Payer: United Healthcare All Other HMO |
$737.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$737.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.19 |
| 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 |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$884.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.34
|
| Rate for Payer: Blue Shield of California EPN |
$860.82
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna of CA HMO |
$943.36
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: IEHP Medi-Cal |
$405.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$405.23
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$884.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$884.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$737.00
|
| Rate for Payer: United Healthcare All Other HMO |
$737.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$737.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$1,252.90 |
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.60
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$38.19 |
| 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 |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$884.40
|
| 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 |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: IEHP Medi-Cal |
$405.23
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$405.23
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| 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 |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$660.96 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$569.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna of CA HMO |
$1,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: IEHP Medi-Cal |
$685.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$99.56
|
| Rate for Payer: IEHP Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$569.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,652.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,029.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,608.34
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna of CA HMO |
$1,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: IEHP Medi-Cal |
$685.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$99.56
|
| Rate for Payer: IEHP Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$660.96 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$660.96 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$569.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna of CA HMO |
$1,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: IEHP Medi-Cal |
$685.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$99.56
|
| Rate for Payer: IEHP Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$756.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant Transplant |
$630.00
|
| Rate for Payer: Blue Shield of California Commercial |
$773.85
|
| Rate for Payer: Blue Shield of California EPN |
$613.20
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO |
$672.00
|
| Rate for Payer: Cigna of CA PPO |
$777.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$787.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: IEHP Medi-Cal |
$685.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$142.37
|
| Rate for Payer: IEHP Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$630.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
|
