|
HC CYLINDER CAST-THIGH TO ANKLE
|
Facility
OP
|
$699.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
950510041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.76 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$419.40
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: Cigna of CA PPO |
$517.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$524.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$559.20
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$419.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$419.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.50
|
| Rate for Payer: United Healthcare All Other HMO |
$349.50
|
| Rate for Payer: United Healthcare HMO Rider |
$349.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC CYLINDER CAST-THIGH TO ANKLE
|
Facility
IP
|
$699.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
950510041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.76 |
| Max. Negotiated Rate |
$594.15 |
| Rate for Payer: Cash Price |
$314.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.60
|
| Rate for Payer: Galaxy Health WC |
$594.15
|
| Rate for Payer: Global Benefits Group Commercial |
$419.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.76
|
| Rate for Payer: Multiplan Commercial |
$559.20
|
| Rate for Payer: Networks By Design Commercial |
$454.35
|
| Rate for Payer: Prime Health Services Commercial |
$594.15
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
OP
|
$875.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$299.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$481.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$517.12
|
| Rate for Payer: Blue Shield of California EPN |
$410.38
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Media |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$656.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
IP
|
$875.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
OP
|
$1,477.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$1,255.45 |
| Rate for Payer: Cash Price |
$664.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.01
|
| Rate for Payer: BCBS Transplant Transplant |
$886.20
|
| Rate for Payer: Blue Shield of California Commercial |
$872.91
|
| Rate for Payer: Blue Shield of California EPN |
$692.71
|
| Rate for Payer: Cash Price |
$664.65
|
| Rate for Payer: Cigna of CA HMO |
$945.28
|
| Rate for Payer: Cigna of CA PPO |
$1,092.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$1,255.45
|
| Rate for Payer: Global Benefits Group Commercial |
$886.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,107.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: IEHP Medi-Cal |
$778.41
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$778.41
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$985.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$1,181.60
|
| Rate for Payer: Networks By Design Commercial |
$960.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,255.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$886.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$886.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$886.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
IP
|
$1,477.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$354.48 |
| Max. Negotiated Rate |
$1,255.45 |
| Rate for Payer: Cash Price |
$664.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.80
|
| Rate for Payer: Galaxy Health WC |
$1,255.45
|
| Rate for Payer: Global Benefits Group Commercial |
$886.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$985.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.48
|
| Rate for Payer: Multiplan Commercial |
$1,181.60
|
| Rate for Payer: Networks By Design Commercial |
$960.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,255.45
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
IP
|
$1,558.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.92 |
| Max. Negotiated Rate |
$1,324.30 |
| Rate for Payer: Cash Price |
$701.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.20
|
| Rate for Payer: Galaxy Health WC |
$1,324.30
|
| Rate for Payer: Global Benefits Group Commercial |
$934.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.92
|
| Rate for Payer: Multiplan Commercial |
$1,246.40
|
| Rate for Payer: Networks By Design Commercial |
$1,012.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,324.30
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
OP
|
$1,558.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| 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 |
$934.80
|
| Rate for Payer: Cash Price |
$701.10
|
| Rate for Payer: Cash Price |
$701.10
|
| Rate for Payer: Cash Price |
$701.10
|
| Rate for Payer: Cigna of CA PPO |
$1,152.92
|
| 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 |
$1,324.30
|
| Rate for Payer: Global Benefits Group Commercial |
$934.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,168.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.92
|
| 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 |
$1,246.40
|
| Rate for Payer: Networks By Design Commercial |
$1,012.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,324.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$934.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$934.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$779.00
|
| Rate for Payer: United Healthcare All Other HMO |
$779.00
|
| Rate for Payer: United Healthcare HMO Rider |
$779.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.00
|
| 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
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
OP
|
$9,497.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,698.20
|
| Rate for Payer: Cash Price |
$4,273.65
|
| Rate for Payer: Cash Price |
$4,273.65
|
| Rate for Payer: Cash Price |
$4,273.65
|
| Rate for Payer: Cigna of CA PPO |
$7,027.78
|
| 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 |
$8,072.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,698.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,122.75
|
| 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 |
$6,334.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,279.28
|
| 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 |
$7,597.60
|
| Rate for Payer: Networks By Design Commercial |
$6,173.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,072.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,698.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,698.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,748.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,748.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,748.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,748.50
|
| 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 CYSTOSTOMY W DRAINAGE
|
Facility
IP
|
$9,497.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,279.28 |
| Max. Negotiated Rate |
$8,072.45 |
| Rate for Payer: Cash Price |
$4,273.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,798.80
|
| Rate for Payer: Galaxy Health WC |
$8,072.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,698.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,334.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,618.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,279.28
|
| Rate for Payer: Multiplan Commercial |
$7,597.60
|
| Rate for Payer: Networks By Design Commercial |
$6,173.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,072.45
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.76 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,224.60
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cigna of CA PPO |
$1,510.34
|
| 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 |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,530.75
|
| 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 |
$1,361.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.84
|
| 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 |
$1,632.80
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,224.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,020.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,020.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,020.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,020.50
|
| 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 CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
IP
|
$2,041.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$489.84 |
| Max. Negotiated Rate |
$1,734.85 |
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$816.40
|
| Rate for Payer: Galaxy Health WC |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,361.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$777.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.84
|
| Rate for Payer: Multiplan Commercial |
$1,632.80
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
OP
|
$3,661.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,938.00 |
| 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 |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,196.60
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: Cigna of CA PPO |
$2,709.14
|
| 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 |
$3,111.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,745.75
|
| 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 |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.64
|
| 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 |
$2,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,379.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,196.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,830.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,830.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,830.50
|
| 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 CYSTOURETHROSCOPY
|
Facility
IP
|
$3,661.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$878.64 |
| Max. Negotiated Rate |
$3,111.85 |
| Rate for Payer: Cash Price |
$1,647.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,464.40
|
| Rate for Payer: Galaxy Health WC |
$3,111.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,394.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.64
|
| Rate for Payer: Multiplan Commercial |
$2,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,379.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.85
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$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 |
$5,026.80
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| 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 |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,283.50
|
| 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 |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| 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 |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,026.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.00
|
| 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 CYSTOURETHROSCOPY, W/DILATION
|
Facility
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,010.72 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,192.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
IP
|
$9,147.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,195.28 |
| Max. Negotiated Rate |
$7,774.95 |
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.80
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,101.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,485.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
|
|
HC CYSTOURETHROSCOPY W/RMVL F B
|
Facility
OP
|
$9,147.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
900501293
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.23 |
| Max. Negotiated Rate |
$7,774.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$5,488.20
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: Cigna of CA PPO |
$6,768.78
|
| 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 |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,860.25
|
| 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 |
$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 |
$6,101.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| 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 |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,488.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,488.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,573.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,573.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,573.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,573.50
|
| 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 CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
IP
|
$10,473.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,513.52 |
| Max. Negotiated Rate |
$8,902.05 |
| Rate for Payer: Cash Price |
$4,712.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,189.20
|
| Rate for Payer: Galaxy Health WC |
$8,902.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,283.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,985.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,990.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,513.52
|
| Rate for Payer: Multiplan Commercial |
$8,378.40
|
| Rate for Payer: Networks By Design Commercial |
$6,807.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,902.05
|
|
|
HC CYSTOURETHROSCOPY,W/UTERAL CAT
|
Facility
OP
|
$10,473.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
900501312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$8,902.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,283.80
|
| Rate for Payer: Cash Price |
$4,712.85
|
| Rate for Payer: Cash Price |
$4,712.85
|
| Rate for Payer: Cash Price |
$4,712.85
|
| Rate for Payer: Cigna of CA PPO |
$7,750.02
|
| 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 |
$8,902.05
|
| Rate for Payer: Global Benefits Group Commercial |
$6,283.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,854.75
|
| 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 |
$6,985.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,513.52
|
| 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 |
$8,378.40
|
| Rate for Payer: Networks By Design Commercial |
$6,807.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,902.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,283.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,283.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,236.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,236.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,236.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,236.50
|
| 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 CYSTOURETHRO W LITHO INC STNT
|
Facility
OP
|
$12,835.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.71 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,701.00
|
| Rate for Payer: Cash Price |
$5,775.75
|
| Rate for Payer: Cash Price |
$5,775.75
|
| Rate for Payer: Cash Price |
$5,775.75
|
| Rate for Payer: Cigna of CA PPO |
$9,497.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Media |
$6,465.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$10,909.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,626.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,602.62
|
| Rate for Payer: Heritage Provider Network Transplant |
$10,602.62
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,560.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,080.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$10,268.00
|
| Rate for Payer: Networks By Design Commercial |
$8,342.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,909.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,701.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,701.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,417.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,417.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,417.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,417.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC CYSTOURETHRO W LITHO INC STNT
|
Facility
IP
|
$12,835.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
900052356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,080.40 |
| Max. Negotiated Rate |
$10,909.75 |
| Rate for Payer: Cash Price |
$5,775.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,134.00
|
| Rate for Payer: Galaxy Health WC |
$10,909.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,701.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,560.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,890.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,080.40
|
| Rate for Payer: Multiplan Commercial |
$10,268.00
|
| Rate for Payer: Networks By Design Commercial |
$8,342.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,909.75
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$349.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.90
|
| Rate for Payer: BCBS Transplant Transplant |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$68.48
|
| Rate for Payer: Blue Shield of California EPN |
$54.27
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$79.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$349.99
|
| Rate for Payer: IEHP Medi-Cal |
$345.72
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$345.72
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC CYTO FNA EVAL, 1ST EA SITE
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800008
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$318.75 |
| Rate for Payer: Cash Price |
$168.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
|
HC CYTO FNA EVAL,EA ADDL SAME SIT
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$173.40 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
