|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
OP
|
$7,336.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$286.48 |
| 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 |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,401.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,301.20
|
| Rate for Payer: Cash Price |
$3,301.20
|
| Rate for Payer: Cigna of CA PPO |
$5,428.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$6,235.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,401.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,502.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,418.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,418.05
|
| Rate for Payer: IEHP Medi-Cal |
$2,388.56
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,388.56
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$286.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$5,868.80
|
| Rate for Payer: Networks By Design Commercial |
$4,768.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,235.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,401.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| 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 |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DILAT ANAL SPHINC UNDER ANES
|
Facility
IP
|
$13,288.00
|
|
|
Service Code
|
CPT 45905
|
| Hospital Charge Code |
906745905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,189.12 |
| Max. Negotiated Rate |
$11,294.80 |
| Rate for Payer: EPIC Health Plan Commercial |
$5,315.20
|
| Rate for Payer: Cash Price |
$5,979.60
|
| Rate for Payer: Galaxy Health WC |
$11,294.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,972.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,863.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,062.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,189.12
|
| Rate for Payer: Multiplan Commercial |
$10,630.40
|
| Rate for Payer: Networks By Design Commercial |
$8,637.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,294.80
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,045.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$676.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$676.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$738.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna of CA PPO |
$910.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Dignity Health Media |
$1,045.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$492.00
|
| Rate for Payer: Galaxy Health WC |
$1,045.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$922.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$820.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.20
|
| Rate for Payer: Multiplan Commercial |
$984.00
|
| Rate for Payer: Networks By Design Commercial |
$799.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,045.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$738.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,045.50
|
|
|
HC DILATE BILIARY OR AMPULLA PERC
|
Facility
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
909047542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,045.50 |
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.00
|
| Rate for Payer: Galaxy Health WC |
$1,045.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$820.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.20
|
| Rate for Payer: Multiplan Commercial |
$984.00
|
| Rate for Payer: Networks By Design Commercial |
$799.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,045.50
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$88.43 |
| 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 |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,088.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cigna of CA PPO |
$2,575.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,610.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$1,834.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,784.80
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
IP
|
$6,678.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,602.72 |
| Max. Negotiated Rate |
$5,676.30 |
| Rate for Payer: Cash Price |
$3,005.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,671.20
|
| Rate for Payer: Galaxy Health WC |
$5,676.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,006.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,544.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.72
|
| Rate for Payer: Multiplan Commercial |
$5,342.40
|
| Rate for Payer: Networks By Design Commercial |
$4,340.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,676.30
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.43 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,088.60
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cigna of CA PPO |
$2,575.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,610.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,784.80
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,088.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,740.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,740.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,740.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,740.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
IP
|
$6,678.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,602.72 |
| Max. Negotiated Rate |
$5,676.30 |
| Rate for Payer: Cash Price |
$3,005.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,671.20
|
| Rate for Payer: Galaxy Health WC |
$5,676.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,006.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,454.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,544.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.72
|
| Rate for Payer: Multiplan Commercial |
$5,342.40
|
| Rate for Payer: Networks By Design Commercial |
$4,340.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,676.30
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
OP
|
$3,475.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$190.99 |
| 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 |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,085.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna of CA PPO |
$2,571.50
|
| 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 |
$2,953.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,085.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,606.25
|
| 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 |
$2,317.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$834.00
|
| 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 |
$2,780.00
|
| Rate for Payer: Networks By Design Commercial |
$2,258.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,953.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,085.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| 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 DILAT ESOPH OVER GUIDE WIRE
|
Facility
IP
|
$5,334.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,280.16 |
| Max. Negotiated Rate |
$4,533.90 |
| Rate for Payer: Cash Price |
$2,400.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,133.60
|
| Rate for Payer: Galaxy Health WC |
$4,533.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,200.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,557.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,032.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.16
|
| Rate for Payer: Multiplan Commercial |
$4,267.20
|
| Rate for Payer: Networks By Design Commercial |
$3,467.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,533.90
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$149.40
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA PPO |
$184.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$186.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
OP
|
$16,982.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.34 |
| Max. Negotiated Rate |
$14,434.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,189.20
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: Cigna of CA PPO |
$12,566.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$14,434.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,736.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,326.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,075.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$13,585.60
|
| Rate for Payer: Networks By Design Commercial |
$11,038.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,434.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,491.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,491.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,491.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,491.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
IP
|
$16,982.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,075.68 |
| Max. Negotiated Rate |
$14,434.70 |
| Rate for Payer: Cash Price |
$7,641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,792.80
|
| Rate for Payer: Galaxy Health WC |
$14,434.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,326.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,470.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,075.68
|
| Rate for Payer: Multiplan Commercial |
$13,585.60
|
| Rate for Payer: Networks By Design Commercial |
$11,038.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,434.70
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
IP
|
$13,633.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,271.92 |
| Max. Negotiated Rate |
$11,588.05 |
| Rate for Payer: Cash Price |
$6,134.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.20
|
| Rate for Payer: Galaxy Health WC |
$11,588.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,179.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,093.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,194.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,271.92
|
| Rate for Payer: Multiplan Commercial |
$10,906.40
|
| Rate for Payer: Networks By Design Commercial |
$8,861.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,588.05
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
OP
|
$7,526.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$200.89 |
| 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 |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,515.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cigna of CA PPO |
$5,569.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$6,397.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,515.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,644.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,418.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,418.05
|
| Rate for Payer: IEHP Medi-Cal |
$2,388.56
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,388.56
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,019.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,806.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$6,020.80
|
| Rate for Payer: Networks By Design Commercial |
$4,891.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,397.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,515.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| 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 |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
OP
|
$8,954.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$415.93 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,372.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: Cigna of CA PPO |
$6,625.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$7,610.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,372.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: IEHP Medi-Cal |
$7,056.27
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,148.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$7,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,820.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,610.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,372.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,372.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
IP
|
$8,954.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,148.96 |
| Max. Negotiated Rate |
$7,610.90 |
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,581.60
|
| Rate for Payer: Galaxy Health WC |
$7,610.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,372.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,411.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,148.96
|
| Rate for Payer: Multiplan Commercial |
$7,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,820.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,610.90
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
OP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: BCBS Transplant Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$630.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,316.15
|
| Rate for Payer: IEHP Medi-Cal |
$1,300.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,300.10
|
| Rate for Payer: IEHP Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
IP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
IP
|
$840.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
OP
|
$840.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$141.93 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: BCBS Transplant Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
OP
|
$840.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$196.65 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: BCBS Transplant Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
IP
|
$840.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
IP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
