|
HC PREVIEW TRT PLANNING
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$652.56 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,495.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,619.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,631.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,606.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,275.21
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO |
$1,740.16
|
| Rate for Payer: Cigna of CA PPO |
$2,012.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Media |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,087.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,087.60
|
| Rate for Payer: Galaxy Health WC |
$2,311.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,631.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,039.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,813.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.56
|
| Rate for Payer: Multiplan Commercial |
$2,175.20
|
| Rate for Payer: Networks By Design Commercial |
$1,767.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,311.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,631.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,359.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,359.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,359.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,359.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
908603033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.64
|
| Rate for Payer: Blue Distinction Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.19
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Media |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
908603033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.52
|
| Rate for Payer: Blue Distinction Transplant |
$69.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.96
|
| Rate for Payer: Blue Shield of California EPN |
$53.94
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Media |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$86.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$77.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$12,250.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,940.00 |
| Max. Negotiated Rate |
$10,412.50 |
| Rate for Payer: Cash Price |
$5,512.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,900.00
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,667.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Multiplan Commercial |
$9,800.00
|
| Rate for Payer: Networks By Design Commercial |
$7,962.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$12,250.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$769.61 |
| Max. Negotiated Rate |
$35,930.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,350.00
|
| 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 |
$5,512.50
|
| Rate for Payer: Cash Price |
$5,512.50
|
| Rate for Payer: Cigna of CA PPO |
$9,065.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,187.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$9,800.00
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$7,962.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$12,250.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,940.00 |
| Max. Negotiated Rate |
$10,412.50 |
| Rate for Payer: Cash Price |
$5,512.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,900.00
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,667.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Multiplan Commercial |
$9,800.00
|
| Rate for Payer: Networks By Design Commercial |
$7,962.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$12,250.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$769.61 |
| Max. Negotiated Rate |
$35,930.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,350.00
|
| 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 |
$5,512.50
|
| Rate for Payer: Cash Price |
$5,512.50
|
| Rate for Payer: Cigna of CA PPO |
$9,065.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$10,412.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,350.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,187.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$9,800.00
|
| Rate for Payer: Networks By Design Commercial |
$7,962.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,412.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,350.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,350.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$10,287.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$8,743.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,743.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,657.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,657.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,172.20
|
| 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 |
$4,629.15
|
| Rate for Payer: Cash Price |
$4,629.15
|
| Rate for Payer: Cigna of CA PPO |
$7,612.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,743.95
|
| Rate for Payer: Dignity Health Media |
$8,743.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,743.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,114.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,114.80
|
| Rate for Payer: Galaxy Health WC |
$8,743.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,172.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,715.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,861.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,468.88
|
| Rate for Payer: Multiplan Commercial |
$8,229.60
|
| Rate for Payer: Networks By Design Commercial |
$6,686.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,743.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,172.20
|
| 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 |
$8,743.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,743.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,743.95
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$10,287.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,468.88 |
| Max. Negotiated Rate |
$8,743.95 |
| Rate for Payer: Cash Price |
$4,629.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,114.80
|
| Rate for Payer: Galaxy Health WC |
$8,743.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,861.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,919.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,468.88
|
| Rate for Payer: Multiplan Commercial |
$8,229.60
|
| Rate for Payer: Networks By Design Commercial |
$6,686.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,743.95
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
IP
|
$3,789.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$909.36 |
| Max. Negotiated Rate |
$3,220.65 |
| Rate for Payer: Cash Price |
$1,705.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,515.60
|
| Rate for Payer: Galaxy Health WC |
$3,220.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,273.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,527.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.36
|
| Rate for Payer: Multiplan Commercial |
$3,031.20
|
| Rate for Payer: Networks By Design Commercial |
$2,462.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,220.65
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
OP
|
$3,789.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.91 |
| 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 |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,273.40
|
| Rate for Payer: Cash Price |
$1,705.05
|
| Rate for Payer: Cash Price |
$1,705.05
|
| Rate for Payer: Cash Price |
$1,705.05
|
| Rate for Payer: Cigna of CA PPO |
$2,803.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$3,220.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,273.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,841.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| 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 |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,527.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$909.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$3,031.20
|
| Rate for Payer: Networks By Design Commercial |
$2,462.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,220.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,273.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,894.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,894.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,894.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,894.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
|
IP
|
$6,680.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
900501677
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,603.20 |
| Max. Negotiated Rate |
$5,678.00 |
| Rate for Payer: Cash Price |
$3,006.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,672.00
|
| Rate for Payer: Galaxy Health WC |
$5,678.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,008.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,545.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.20
|
| Rate for Payer: Multiplan Commercial |
$5,344.00
|
| Rate for Payer: Networks By Design Commercial |
$4,342.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,678.00
|
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
|
OP
|
$6,680.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
900501677
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.17 |
| 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 |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,008.00
|
| Rate for Payer: Cash Price |
$3,006.00
|
| Rate for Payer: Cash Price |
$3,006.00
|
| Rate for Payer: Cash Price |
$3,006.00
|
| Rate for Payer: Cigna of CA PPO |
$4,943.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$5,678.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,008.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,010.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| 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 |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$5,344.00
|
| Rate for Payer: Networks By Design Commercial |
$4,342.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,678.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,008.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,340.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,340.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,340.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
|
OP
|
$2,435.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
900501582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.98 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,461.00
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Cigna of CA PPO |
$1,801.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$2,069.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,826.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| 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 |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: Networks By Design Commercial |
$1,582.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,069.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
|
IP
|
$2,435.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
900501582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$584.40 |
| Max. Negotiated Rate |
$2,069.75 |
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.00
|
| Rate for Payer: Galaxy Health WC |
$2,069.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.40
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: Networks By Design Commercial |
$1,582.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,069.75
|
|
|
HC PROB-NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900912306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$309.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$282.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.76
|
| Rate for Payer: Blue Distinction Transplant |
$57.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.37
|
| Rate for Payer: Blue Shield of California EPN |
$48.64
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
| Rate for Payer: Dignity Health Media |
$39.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.26
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.39
|
| Rate for Payer: Heritage Provider Network Transplant |
$64.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$63.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.80
|
| Rate for Payer: United Healthcare All Other HMO |
$31.80
|
| Rate for Payer: United Healthcare HMO Rider |
$31.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Vantage Medical Group Senior |
$39.26
|
|
|
HC PROCALCITONIN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
900912171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$222.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Blue Distinction Transplant |
$61.20
|
| Rate for Payer: Blue Shield of California Commercial |
$65.89
|
| Rate for Payer: Blue Shield of California EPN |
$52.22
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO |
$65.28
|
| Rate for Payer: Cigna of CA PPO |
$75.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.83
|
| Rate for Payer: Dignity Health Media |
$27.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$86.70
|
| Rate for Payer: Global Benefits Group Commercial |
$61.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$44.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$44.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.47
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Networks By Design Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Commercial |
$86.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.05
|
| Rate for Payer: United Healthcare All Other HMO |
$22.05
|
| Rate for Payer: United Healthcare HMO Rider |
$22.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Vantage Medical Group Senior |
$27.22
|
|
|
HC PROC BILIARY TRACT
|
Facility
|
IP
|
$7,512.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
907247999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,802.88 |
| Max. Negotiated Rate |
$6,385.20 |
| Rate for Payer: Cash Price |
$3,380.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,004.80
|
| Rate for Payer: Galaxy Health WC |
$6,385.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,507.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,862.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.88
|
| Rate for Payer: Multiplan Commercial |
$6,009.60
|
| Rate for Payer: Networks By Design Commercial |
$4,882.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,385.20
|
|
|
HC PROC BILIARY TRACT
|
Facility
|
OP
|
$7,512.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
907247999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$6,385.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,507.20
|
| Rate for Payer: Cash Price |
$3,380.40
|
| Rate for Payer: Cash Price |
$3,380.40
|
| Rate for Payer: Cash Price |
$3,380.40
|
| Rate for Payer: Cigna of CA PPO |
$5,558.88
|
| 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 |
$6,385.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,507.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,634.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.88
|
| 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 |
$6,009.60
|
| Rate for Payer: Networks By Design Commercial |
$4,882.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,385.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,507.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,756.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,756.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,756.00
|
| 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 PROC DENTOALVEOLAR STRUCTR
|
Facility
|
IP
|
$6,224.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,493.76 |
| Max. Negotiated Rate |
$5,290.40 |
| Rate for Payer: Cash Price |
$2,800.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,489.60
|
| Rate for Payer: Galaxy Health WC |
$5,290.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,734.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,371.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.76
|
| Rate for Payer: Multiplan Commercial |
$4,979.20
|
| Rate for Payer: Networks By Design Commercial |
$4,045.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,290.40
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
OP
|
$6,224.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,734.40
|
| Rate for Payer: Cash Price |
$2,800.80
|
| Rate for Payer: Cash Price |
$2,800.80
|
| Rate for Payer: Cash Price |
$2,800.80
|
| Rate for Payer: Cigna of CA PPO |
$4,605.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$5,290.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,734.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,668.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| 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 |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,151.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$4,979.20
|
| Rate for Payer: Networks By Design Commercial |
$4,045.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,290.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,112.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,112.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,112.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
OP
|
$6,224.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,734.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,587.09
|
| Rate for Payer: Blue Shield of California EPN |
$3,634.82
|
| Rate for Payer: Cash Price |
$2,800.80
|
| Rate for Payer: Cash Price |
$2,800.80
|
| Rate for Payer: Cash Price |
$2,800.80
|
| Rate for Payer: Cigna of CA HMO |
$3,983.36
|
| Rate for Payer: Cigna of CA PPO |
$4,605.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$5,290.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,734.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,668.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$494.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$494.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,151.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$4,979.20
|
| Rate for Payer: Networks By Design Commercial |
$4,045.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,290.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,734.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,734.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
