|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
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
|
IP
|
$5,825.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| 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
|
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 TUNNEL PLEURAL CATH
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,443.75 |
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,868.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
|
|
HC REMOVE TUNNEL PLEURAL CATH
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$290.02 |
| 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 |
$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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,725.00
|
| 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 |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA PPO |
$2,127.50
|
| 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 |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,156.25
|
| 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 |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.00
|
| 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 |
$2,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,868.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,725.00
|
| 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 URETER STENT, PERCUT
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,468.16 |
| Max. Negotiated Rate |
$8,741.40 |
| Rate for Payer: Cash Price |
$4,627.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,113.60
|
| Rate for Payer: Galaxy Health WC |
$8,741.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,859.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,918.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,468.16
|
| Rate for Payer: Multiplan Commercial |
$8,227.20
|
| Rate for Payer: Networks By Design Commercial |
$6,684.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,741.40
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
OP
|
$10,284.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.09 |
| 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 |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,170.40
|
| 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 |
$4,627.80
|
| Rate for Payer: Cash Price |
$4,627.80
|
| Rate for Payer: Cigna of CA PPO |
$7,610.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$8,741.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,170.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,713.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,859.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,468.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$8,227.20
|
| Rate for Payer: Networks By Design Commercial |
$6,684.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,741.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,170.40
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
OP
|
$7,597.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$315.50 |
| Max. Negotiated Rate |
$8,241.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,210.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,178.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,178.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,558.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,851.81
|
| Rate for Payer: Blue Shield of California EPN |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cigna of CA PPO |
$5,621.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Dignity Health Media |
$6,457.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,457.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,038.80
|
| Rate for Payer: Galaxy Health WC |
$6,457.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,558.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,697.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.28
|
| Rate for Payer: Multiplan Commercial |
$6,077.60
|
| Rate for Payer: Networks By Design Commercial |
$4,938.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,457.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,558.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,558.20
|
| 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 |
$6,457.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,457.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,457.45
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
IP
|
$7,597.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,823.28 |
| Max. Negotiated Rate |
$6,457.45 |
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.80
|
| Rate for Payer: Galaxy Health WC |
$6,457.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,558.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,894.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.28
|
| Rate for Payer: Multiplan Commercial |
$6,077.60
|
| Rate for Payer: Networks By Design Commercial |
$4,938.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,457.45
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,549.60
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cigna of CA PPO |
$4,377.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,437.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: Networks By Design Commercial |
$3,845.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,958.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,958.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,958.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,419.84 |
| Max. Negotiated Rate |
$5,028.60 |
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,254.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.84
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: Networks By Design Commercial |
$3,845.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
IP
|
$6,501.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,560.24 |
| Max. Negotiated Rate |
$5,525.85 |
| Rate for Payer: Cash Price |
$2,925.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,600.40
|
| Rate for Payer: Galaxy Health WC |
$5,525.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,900.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,476.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.24
|
| Rate for Payer: Multiplan Commercial |
$5,200.80
|
| Rate for Payer: Networks By Design Commercial |
$4,225.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,525.85
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$6,501.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.17 |
| 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 |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,900.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,925.45
|
| Rate for Payer: Cash Price |
$2,925.45
|
| Rate for Payer: Cigna of CA PPO |
$4,810.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,525.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,900.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,875.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$5,200.80
|
| Rate for Payer: Networks By Design Commercial |
$4,225.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,525.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
IP
|
$6,501.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,560.24 |
| Max. Negotiated Rate |
$5,525.85 |
| Rate for Payer: Cash Price |
$2,925.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,600.40
|
| Rate for Payer: Galaxy Health WC |
$5,525.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,900.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,476.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.24
|
| Rate for Payer: Multiplan Commercial |
$5,200.80
|
| Rate for Payer: Networks By Design Commercial |
$4,225.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,525.85
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$6,501.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.17 |
| 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 |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,900.60
|
| Rate for Payer: Cash Price |
$2,925.45
|
| Rate for Payer: Cash Price |
$2,925.45
|
| Rate for Payer: Cash Price |
$2,925.45
|
| Rate for Payer: Cigna of CA PPO |
$4,810.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$5,525.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,900.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,875.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$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 |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,560.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$5,200.80
|
| Rate for Payer: Networks By Design Commercial |
$4,225.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,525.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,900.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,250.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,250.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,250.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,250.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.48 |
| Max. Negotiated Rate |
$2,424.20 |
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.80
|
| Rate for Payer: Galaxy Health WC |
$2,424.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.48
|
| Rate for Payer: Multiplan Commercial |
$2,281.60
|
| Rate for Payer: Networks By Design Commercial |
$1,853.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,424.20
|
|
|
HC RENAL ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,568.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,699.22
|
| Rate for Payer: Blue Distinction Transplant |
$1,711.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cigna of CA PPO |
$2,110.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Dignity Health Media |
$2,424.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,424.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,140.80
|
| Rate for Payer: Galaxy Health WC |
$2,424.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,711.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,139.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,086.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.48
|
| Rate for Payer: Multiplan Commercial |
$2,281.60
|
| Rate for Payer: Networks By Design Commercial |
$1,853.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,424.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,711.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,426.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,426.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,426.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,426.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,424.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,424.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,424.20
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
IP
|
$8,641.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,073.84 |
| Max. Negotiated Rate |
$7,344.85 |
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,456.40
|
| Rate for Payer: Galaxy Health WC |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,763.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,292.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,073.84
|
| Rate for Payer: Multiplan Commercial |
$6,912.80
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
|
|
HC RENAL BILAT 2ND ORDER
|
Facility
|
OP
|
$8,641.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
909036254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$648.26 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,184.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cigna of CA PPO |
$6,394.34
|
| 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 |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,480.75
|
| 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 |
$5,763.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$648.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,073.84
|
| 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 |
$6,912.80
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,184.60
|
| 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 RENAL BILAT SELECTIVE INC AO
|
Facility
|
IP
|
$9,075.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,178.00 |
| Max. Negotiated Rate |
$7,713.75 |
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.00
|
| Rate for Payer: Galaxy Health WC |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,053.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,457.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
|
|
HC RENAL BILAT SELECTIVE INC AO
|
Facility
|
OP
|
$9,075.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
909036252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$563.43 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cigna of CA PPO |
$6,715.50
|
| 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 |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,806.25
|
| 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 |
$6,053.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,445.00
|
| 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 RENAL BIOP PERCUT BY NEEDLE
|
Facility
|
IP
|
$4,891.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
903800069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,173.84 |
| Max. Negotiated Rate |
$4,157.35 |
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.40
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,173.84
|
| Rate for Payer: Multiplan Commercial |
$3,912.80
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
|
|
HC RENAL BIOP PERCUT BY NEEDLE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
903800069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.20 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$198.00
|
| 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 |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA PPO |
$244.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$247.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
IP
|
$4,891.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,173.84 |
| Max. Negotiated Rate |
$4,157.35 |
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.40
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,173.84
|
| Rate for Payer: Multiplan Commercial |
$3,912.80
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
|
|
HC RENAL BIOPSY,PERCUTANEOUS
|
Facility
|
OP
|
$4,891.00
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
909000163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.41 |
| 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 |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,934.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Cigna of CA PPO |
$3,619.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,668.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,173.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,912.80
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,934.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
