|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
IP
|
$17,191.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,125.84 |
| Max. Negotiated Rate |
$14,612.35 |
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,876.40
|
| Rate for Payer: Galaxy Health WC |
$14,612.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,314.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,466.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,549.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,125.84
|
| Rate for Payer: Multiplan Commercial |
$13,752.80
|
| Rate for Payer: Networks By Design Commercial |
$11,174.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,612.35
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
OP
|
$17,191.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.04 |
| Max. Negotiated Rate |
$14,612.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,314.60
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cigna of CA PPO |
$12,721.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$14,612.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,314.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,893.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,466.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,125.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$13,752.80
|
| Rate for Payer: Networks By Design Commercial |
$11,174.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,612.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,314.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,595.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,595.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,595.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,595.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.60 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.60 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$829.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$753.69
|
| Rate for Payer: Blue Distinction Transplant |
$759.00
|
| 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 |
$569.25
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$948.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
IP
|
$18,556.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,453.44 |
| Max. Negotiated Rate |
$15,772.60 |
| Rate for Payer: Cash Price |
$8,350.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,422.40
|
| Rate for Payer: Galaxy Health WC |
$15,772.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,133.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,376.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,069.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,453.44
|
| Rate for Payer: Multiplan Commercial |
$14,844.80
|
| Rate for Payer: Networks By Design Commercial |
$12,061.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,772.60
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
OP
|
$18,556.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,429.00 |
| Max. Negotiated Rate |
$26,968.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$11,133.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$8,350.20
|
| Rate for Payer: Cash Price |
$8,350.20
|
| Rate for Payer: Cigna of CA PPO |
$13,731.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Media |
$16,443.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$16,443.97
|
| Rate for Payer: Galaxy Health WC |
$15,772.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,133.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,917.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,968.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$26,968.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26,639.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,376.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,988.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,443.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,453.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,034.92
|
| Rate for Payer: Multiplan Commercial |
$14,844.80
|
| Rate for Payer: Multiplan WC |
$22,481.26
|
| Rate for Payer: Networks By Design Commercial |
$12,061.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,772.60
|
| Rate for Payer: Prime Health Services WC |
$22,251.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,133.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
IP
|
$17,191.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,125.84 |
| Max. Negotiated Rate |
$14,612.35 |
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,876.40
|
| Rate for Payer: Galaxy Health WC |
$14,612.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,314.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,466.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,549.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,125.84
|
| Rate for Payer: Multiplan Commercial |
$13,752.80
|
| Rate for Payer: Networks By Design Commercial |
$11,174.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,612.35
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
OP
|
$17,191.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.94 |
| Max. Negotiated Rate |
$14,612.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,314.60
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cash Price |
$7,735.95
|
| Rate for Payer: Cigna of CA PPO |
$12,721.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$14,612.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,314.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,893.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,466.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$693.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,125.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$13,752.80
|
| Rate for Payer: Networks By Design Commercial |
$11,174.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,612.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,314.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,595.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,595.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,595.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,595.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
IP
|
$9,234.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,216.16 |
| Max. Negotiated Rate |
$7,848.90 |
| Rate for Payer: Cash Price |
$4,155.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,693.60
|
| Rate for Payer: Galaxy Health WC |
$7,848.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,540.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,159.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,518.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,216.16
|
| Rate for Payer: Multiplan Commercial |
$7,387.20
|
| Rate for Payer: Networks By Design Commercial |
$6,002.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,848.90
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
OP
|
$9,234.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.46 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,540.40
|
| Rate for Payer: Cash Price |
$4,155.30
|
| Rate for Payer: Cash Price |
$4,155.30
|
| Rate for Payer: Cash Price |
$4,155.30
|
| Rate for Payer: Cigna of CA PPO |
$6,833.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$7,848.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,540.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,925.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,159.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,216.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$7,387.20
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$6,002.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,848.90
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,540.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,617.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,617.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,617.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,617.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$1,674.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$505.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,674.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,083.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,083.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.06
|
| Rate for Payer: Blue Distinction Transplant |
$1,182.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,164.27
|
| Rate for Payer: Blue Shield of California EPN |
$923.93
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna of CA HMO |
$1,260.80
|
| Rate for Payer: Cigna of CA PPO |
$1,457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,674.50
|
| Rate for Payer: Dignity Health Media |
$1,674.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,674.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$788.00
|
| Rate for Payer: Galaxy Health WC |
$1,674.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,477.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.80
|
| Rate for Payer: Multiplan Commercial |
$1,576.00
|
| Rate for Payer: Networks By Design Commercial |
$1,280.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,674.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,182.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$985.00
|
| Rate for Payer: United Healthcare All Other HMO |
$985.00
|
| Rate for Payer: United Healthcare HMO Rider |
$985.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$985.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,674.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,674.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,674.50
|
|
|
HC PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$472.80 |
| Max. Negotiated Rate |
$1,674.50 |
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.00
|
| Rate for Payer: Galaxy Health WC |
$1,674.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.80
|
| Rate for Payer: Multiplan Commercial |
$1,576.00
|
| Rate for Payer: Networks By Design Commercial |
$1,280.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,674.50
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
OP
|
$17,550.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$481.73 |
| Max. Negotiated Rate |
$14,917.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,530.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,372.05
|
| Rate for Payer: Blue Shield of California EPN |
$8,230.95
|
| Rate for Payer: Cash Price |
$7,897.50
|
| Rate for Payer: Cash Price |
$7,897.50
|
| Rate for Payer: Cigna of CA HMO |
$11,232.00
|
| Rate for Payer: Cigna of CA PPO |
$12,987.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$14,917.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,530.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,162.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,705.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,212.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$14,040.00
|
| Rate for Payer: Networks By Design Commercial |
$11,407.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,917.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,775.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,775.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,775.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
IP
|
$17,550.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,212.00 |
| Max. Negotiated Rate |
$14,917.50 |
| Rate for Payer: Cash Price |
$7,897.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,020.00
|
| Rate for Payer: Galaxy Health WC |
$14,917.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,530.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,705.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,686.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,212.00
|
| Rate for Payer: Multiplan Commercial |
$14,040.00
|
| Rate for Payer: Networks By Design Commercial |
$11,407.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,917.50
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
IP
|
$14,982.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,595.68 |
| Max. Negotiated Rate |
$12,734.70 |
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,992.80
|
| Rate for Payer: Galaxy Health WC |
$12,734.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,989.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,992.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,708.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,595.68
|
| Rate for Payer: Multiplan Commercial |
$11,985.60
|
| Rate for Payer: Networks By Design Commercial |
$9,738.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,734.70
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
OP
|
$14,982.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.76 |
| Max. Negotiated Rate |
$12,734.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,989.20
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cash Price |
$6,741.90
|
| Rate for Payer: Cigna of CA PPO |
$11,086.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$12,734.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,989.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,236.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,992.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,595.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$11,985.60
|
| Rate for Payer: Networks By Design Commercial |
$9,738.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,734.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,989.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,491.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,491.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,491.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,491.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$5,026.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.58 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,015.60
|
| 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 |
$2,261.70
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Cigna of CA PPO |
$3,719.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,769.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,352.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,020.80
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,015.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$4,272.10 |
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.40
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,352.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.24
|
| Rate for Payer: Multiplan Commercial |
$4,020.80
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$420.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.23
|
| Rate for Payer: Blue Shield of California EPN |
$60.42
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$420.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.23
|
| Rate for Payer: Blue Shield of California EPN |
$60.42
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$298.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cigna of CA PPO |
$367.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.45
|
| Rate for Payer: Dignity Health Media |
$422.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$422.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$422.45
|
| Rate for Payer: Global Benefits Group Commercial |
$298.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$372.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$331.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.28
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: Networks By Design Commercial |
$323.05
|
| Rate for Payer: Prime Health Services Commercial |
$422.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$422.45
|
| Rate for Payer: Vantage Medical Group Senior |
$422.45
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.61 |
| Max. Negotiated Rate |
$1,464.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,464.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.32
|
| Rate for Payer: Blue Distinction Transplant |
$827.40
|
| Rate for Payer: Blue Shield of California Commercial |
$814.99
|
| Rate for Payer: Blue Shield of California EPN |
$646.75
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cigna of CA HMO |
$882.56
|
| Rate for Payer: Cigna of CA PPO |
$1,020.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,034.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$827.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$827.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.28 |
| Max. Negotiated Rate |
$422.45 |
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$422.45
|
| Rate for Payer: Global Benefits Group Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$331.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.28
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: Networks By Design Commercial |
$323.05
|
| Rate for Payer: Prime Health Services Commercial |
$422.45
|
|
