|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
OP
|
$8,133.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$613.28 |
| Max. Negotiated Rate |
$7,810.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,879.80
|
| Rate for Payer: Cash Price |
$3,659.85
|
| Rate for Payer: Cash Price |
$3,659.85
|
| Rate for Payer: Cash Price |
$3,659.85
|
| Rate for Payer: Cigna of CA PPO |
$6,018.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$6,913.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,879.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,099.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,810.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,810.52
|
| 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 |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,424.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$6,506.40
|
| Rate for Payer: Networks By Design Commercial |
$5,286.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,913.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,879.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,066.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,066.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,066.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,066.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$8,133.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,951.92 |
| Max. Negotiated Rate |
$6,913.05 |
| Rate for Payer: Cash Price |
$3,659.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.20
|
| Rate for Payer: Galaxy Health WC |
$6,913.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,879.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,424.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,098.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,951.92
|
| Rate for Payer: Multiplan Commercial |
$6,506.40
|
| Rate for Payer: Networks By Design Commercial |
$5,286.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,913.05
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$18,263.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,002.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,817.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,892.20
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cigna of CA PPO |
$15,900.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Dignity Health Media |
$18,263.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,263.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,594.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,594.80
|
| Rate for Payer: Galaxy Health WC |
$18,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,892.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,115.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,156.88
|
| Rate for Payer: Multiplan Commercial |
$17,189.60
|
| Rate for Payer: Networks By Design Commercial |
$13,966.55
|
| Rate for Payer: Prime Health Services Commercial |
$18,263.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,892.20
|
| 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 |
$18,263.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,263.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18,263.95
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,156.88 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,594.80
|
| Rate for Payer: Galaxy Health WC |
$18,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,892.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,186.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,156.88
|
| Rate for Payer: Multiplan Commercial |
$17,189.60
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,263.95
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$7,266.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,743.84 |
| Max. Negotiated Rate |
$6,176.10 |
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,906.40
|
| Rate for Payer: Galaxy Health WC |
$6,176.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,359.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,846.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,768.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,743.84
|
| Rate for Payer: Multiplan Commercial |
$5,812.80
|
| Rate for Payer: Networks By Design Commercial |
$4,722.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,176.10
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$7,266.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,359.60
|
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: Cigna of CA PPO |
$5,376.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$6,176.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,359.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,449.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| 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 |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,846.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,743.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$5,812.80
|
| Rate for Payer: Networks By Design Commercial |
$4,722.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,176.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,359.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,633.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REMOVE CERCLAGE SUTURE
|
Facility
|
OP
|
$9,308.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
902400749
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$256.08 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,584.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,435.87
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Cigna of CA HMO |
$5,957.12
|
| Rate for Payer: Cigna of CA PPO |
$6,887.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,911.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,584.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,981.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,208.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,233.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: Networks By Design Commercial |
$6,050.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,911.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,584.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,584.80
|
| 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 |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC REMOVE CERCLAGE SUTURE
|
Facility
|
IP
|
$9,308.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
902400749
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,233.92 |
| Max. Negotiated Rate |
$7,911.80 |
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,723.20
|
| Rate for Payer: Galaxy Health WC |
$7,911.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,584.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,208.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,546.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,233.92
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: Networks By Design Commercial |
$6,050.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,911.80
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
|
IP
|
$7,018.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,684.32 |
| Max. Negotiated Rate |
$5,965.30 |
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,807.20
|
| Rate for Payer: Galaxy Health WC |
$5,965.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,210.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,673.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.32
|
| Rate for Payer: Multiplan Commercial |
$5,614.40
|
| Rate for Payer: Networks By Design Commercial |
$4,561.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,965.30
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
|
OP
|
$7,018.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,383.26 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,210.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cigna of CA PPO |
$5,193.32
|
| 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 |
$5,965.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,210.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,263.50
|
| 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 |
$4,681.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,383.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.32
|
| 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 |
$5,614.40
|
| Rate for Payer: Networks By Design Commercial |
$4,561.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,965.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,210.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 REMOVE FOREIGN BODY (RENAL)
|
Facility
|
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.72 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,192.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
|
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$802.16 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,026.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Media |
$6,465.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,283.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,602.62
|
| Rate for Payer: Heritage Provider Network Transplant |
$10,602.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,473.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$10,473.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$948.58 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,026.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Media |
$6,465.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,465.01
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,283.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,602.62
|
| Rate for Payer: Heritage Provider Network Transplant |
$10,602.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,473.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$10,473.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$948.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,465.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,663.11
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.72 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,192.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
IP
|
$2,374.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.76 |
| Max. Negotiated Rate |
$2,017.90 |
| Rate for Payer: Cash Price |
$1,068.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$949.60
|
| Rate for Payer: Galaxy Health WC |
$2,017.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,424.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.76
|
| Rate for Payer: Multiplan Commercial |
$1,899.20
|
| Rate for Payer: Networks By Design Commercial |
$1,543.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,017.90
|
|
|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
OP
|
$2,374.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.76 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,068.30
|
| Rate for Payer: Cash Price |
$1,068.30
|
| Rate for Payer: Cigna of CA PPO |
$1,756.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,017.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,424.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,780.50
|
| 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 |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,583.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$569.76
|
| 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 |
$1,899.20
|
| Rate for Payer: Networks By Design Commercial |
$1,543.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,017.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
|
OP
|
$3,664.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.78 |
| Max. Negotiated Rate |
$3,114.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$912.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,114.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,015.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,015.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$477.33
|
| Rate for Payer: Blue Distinction Transplant |
$2,198.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,165.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,718.42
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: Cigna of CA HMO |
$2,344.96
|
| Rate for Payer: Cigna of CA PPO |
$2,711.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,114.40
|
| Rate for Payer: Dignity Health Media |
$3,114.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,465.60
|
| Rate for Payer: Galaxy Health WC |
$3,114.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,198.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,748.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,443.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.36
|
| Rate for Payer: Multiplan Commercial |
$2,931.20
|
| Rate for Payer: Networks By Design Commercial |
$2,381.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,114.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,198.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,198.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,832.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,832.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,832.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,832.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,114.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,114.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,114.40
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
|
IP
|
$3,664.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$879.36 |
| Max. Negotiated Rate |
$3,114.40 |
| Rate for Payer: Cash Price |
$1,648.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,465.60
|
| Rate for Payer: Galaxy Health WC |
$3,114.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,198.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,443.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,395.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.36
|
| Rate for Payer: Multiplan Commercial |
$2,931.20
|
| Rate for Payer: Networks By Design Commercial |
$2,381.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,114.40
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
IP
|
$11,939.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,865.36 |
| Max. Negotiated Rate |
$10,148.15 |
| Rate for Payer: Cash Price |
$5,372.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,775.60
|
| Rate for Payer: Galaxy Health WC |
$10,148.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,163.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,963.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,548.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.36
|
| Rate for Payer: Multiplan Commercial |
$9,551.20
|
| Rate for Payer: Networks By Design Commercial |
$7,760.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,148.15
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
OP
|
$11,939.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$597.72 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,163.40
|
| 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 |
$5,372.55
|
| Rate for Payer: Cash Price |
$5,372.55
|
| Rate for Payer: Cigna of CA PPO |
$8,834.86
|
| 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 |
$10,148.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,163.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,954.25
|
| 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 |
$7,963.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,865.36
|
| 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 |
$9,551.20
|
| Rate for Payer: Networks By Design Commercial |
$7,760.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,148.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,163.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 REMOVE RENAL TUBE W/FLUORO
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$434.88 |
| 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 |
$1,280.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cigna of CA PPO |
$1,340.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Media |
$853.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$853.50
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,399.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,382.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$863.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$853.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,143.69
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,087.20
|
| 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 |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$434.88 |
| Max. Negotiated Rate |
$1,540.20 |
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.80
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.88
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.19 |
| 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 |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,495.00
|
| 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 |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cigna of CA PPO |
$4,310.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,368.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$4,660.00
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,495.00
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,398.00 |
| Max. Negotiated Rate |
$4,951.25 |
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,330.00
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,219.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.00
|
| Rate for Payer: Multiplan Commercial |
$4,660.00
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.19 |
| 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 |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,495.00
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cash Price |
$2,621.25
|
| Rate for Payer: Cigna of CA PPO |
$4,310.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$4,951.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,495.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,368.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| 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 |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,885.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$4,660.00
|
| Rate for Payer: Networks By Design Commercial |
$3,786.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,951.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,495.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,912.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,912.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,912.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
