|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
OP
|
$38,826.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$33,002.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,783.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,002.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,354.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,354.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$23,295.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cigna of CA HMO |
$24,848.64
|
| Rate for Payer: Cigna of CA PPO |
$28,731.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,002.10
|
| Rate for Payer: Dignity Health Media |
$33,002.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,002.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,530.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$15,530.40
|
| Rate for Payer: Galaxy Health WC |
$33,002.10
|
| Rate for Payer: Global Benefits Group Commercial |
$23,295.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29,119.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,896.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,792.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,318.24
|
| Rate for Payer: Multiplan Commercial |
$31,060.80
|
| Rate for Payer: Networks By Design Commercial |
$25,236.90
|
| Rate for Payer: Prime Health Services Commercial |
$33,002.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23,295.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,295.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,295.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,002.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,002.10
|
| Rate for Payer: Vantage Medical Group Senior |
$33,002.10
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
IP
|
$38,826.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9,318.24 |
| Max. Negotiated Rate |
$33,002.10 |
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,530.40
|
| Rate for Payer: Galaxy Health WC |
$33,002.10
|
| Rate for Payer: Global Benefits Group Commercial |
$23,295.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,896.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,792.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,318.24
|
| Rate for Payer: Multiplan Commercial |
$31,060.80
|
| Rate for Payer: Networks By Design Commercial |
$25,236.90
|
| Rate for Payer: Prime Health Services Commercial |
$33,002.10
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
IP
|
$23,494.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,638.56 |
| Max. Negotiated Rate |
$19,969.90 |
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,397.60
|
| Rate for Payer: Galaxy Health WC |
$19,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,096.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,951.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,638.56
|
| Rate for Payer: Multiplan Commercial |
$18,795.20
|
| Rate for Payer: Networks By Design Commercial |
$15,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,969.90
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
OP
|
$23,494.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,028.24 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,209.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19,969.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12,921.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,921.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$14,096.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cigna of CA PPO |
$17,385.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Dignity Health Media |
$19,969.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,969.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,397.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,397.60
|
| Rate for Payer: Galaxy Health WC |
$19,969.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,096.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17,620.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,638.56
|
| Rate for Payer: Multiplan Commercial |
$18,795.20
|
| Rate for Payer: Networks By Design Commercial |
$15,271.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,969.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14,096.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,096.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,096.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,969.90
|
| Rate for Payer: Vantage Medical Group Senior |
$19,969.90
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
OP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$29,859.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,041.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$21,077.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cigna of CA HMO |
$22,482.56
|
| Rate for Payer: Cigna of CA PPO |
$25,995.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26,346.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,430.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$28,103.20
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21,077.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,077.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,077.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
IP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8,430.96 |
| Max. Negotiated Rate |
$29,859.65 |
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.60
|
| Rate for Payer: Galaxy Health WC |
$29,859.65
|
| Rate for Payer: Global Benefits Group Commercial |
$21,077.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,431.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,384.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,430.96
|
| Rate for Payer: Multiplan Commercial |
$28,103.20
|
| Rate for Payer: Networks By Design Commercial |
$22,833.85
|
| Rate for Payer: Prime Health Services Commercial |
$29,859.65
|
|
|
HC PEL OVULATION STUDY
|
Facility
IP
|
$1,041.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.84 |
| Max. Negotiated Rate |
$884.85 |
| Rate for Payer: Cash Price |
$468.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.40
|
| Rate for Payer: Galaxy Health WC |
$884.85
|
| Rate for Payer: Global Benefits Group Commercial |
$624.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$694.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.84
|
| Rate for Payer: Multiplan Commercial |
$832.80
|
| Rate for Payer: Networks By Design Commercial |
$676.65
|
| Rate for Payer: Prime Health Services Commercial |
$884.85
|
|
|
HC PEL OVULATION STUDY
|
Facility
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$884.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$395.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.23
|
| Rate for Payer: BCBS Transplant Transplant |
$624.60
|
| Rate for Payer: Blue Shield of California Commercial |
$615.23
|
| Rate for Payer: Blue Shield of California EPN |
$488.23
|
| Rate for Payer: Cash Price |
$468.45
|
| Rate for Payer: Cash Price |
$468.45
|
| Rate for Payer: Cigna of CA HMO |
$666.24
|
| Rate for Payer: Cigna of CA PPO |
$770.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$884.85
|
| Rate for Payer: Global Benefits Group Commercial |
$624.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$780.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$694.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$832.80
|
| Rate for Payer: Networks By Design Commercial |
$676.65
|
| Rate for Payer: Prime Health Services Commercial |
$884.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$624.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
OP
|
$7,849.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,709.40
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: Cigna of CA PPO |
$5,808.26
|
| 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 |
$6,671.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,709.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,886.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,883.76
|
| 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 |
$6,279.20
|
| Rate for Payer: Networks By Design Commercial |
$5,101.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,671.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,709.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,709.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,924.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,924.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,924.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,924.50
|
| 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 PELVIC EXAM UNDER ANESTHESIA
|
Facility
IP
|
$7,849.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,883.76 |
| Max. Negotiated Rate |
$6,671.65 |
| Rate for Payer: Cash Price |
$3,532.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,139.60
|
| Rate for Payer: Galaxy Health WC |
$6,671.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,709.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,990.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,883.76
|
| Rate for Payer: Multiplan Commercial |
$6,279.20
|
| Rate for Payer: Networks By Design Commercial |
$5,101.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,671.65
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
OP
|
$760.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.24
|
| Rate for Payer: BCBS Transplant Transplant |
$456.00
|
| Rate for Payer: Blue Shield of California Commercial |
$449.16
|
| Rate for Payer: Blue Shield of California EPN |
$356.44
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna of CA HMO |
$486.40
|
| Rate for Payer: Cigna of CA PPO |
$562.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$570.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$456.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
IP
|
$760.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.40 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.00
|
| Rate for Payer: Galaxy Health WC |
$646.00
|
| Rate for Payer: Global Benefits Group Commercial |
$456.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.40
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Networks By Design Commercial |
$494.00
|
| Rate for Payer: Prime Health Services Commercial |
$646.00
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
OP
|
$1,217.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$195.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.94
|
| Rate for Payer: BCBS Transplant Transplant |
$730.20
|
| Rate for Payer: Blue Shield of California Commercial |
$719.25
|
| Rate for Payer: Blue Shield of California EPN |
$570.77
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Cigna of CA HMO |
$778.88
|
| Rate for Payer: Cigna of CA PPO |
$900.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$912.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Networks By Design Commercial |
$791.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$730.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$730.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
IP
|
$1,217.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.08 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.08
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Networks By Design Commercial |
$791.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
|
|
HC PENILE INJECTION
|
Facility
IP
|
$2,029.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.96 |
| Max. Negotiated Rate |
$1,724.65 |
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$811.60
|
| Rate for Payer: Galaxy Health WC |
$1,724.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,217.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.96
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: Networks By Design Commercial |
$1,318.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,724.65
|
|
|
HC PENILE INJECTION
|
Facility
OP
|
$2,029.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,217.40
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cigna of CA PPO |
$1,501.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,724.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,217.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,521.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: Networks By Design Commercial |
$1,318.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,724.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,217.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,217.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,014.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,014.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,014.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$371.76 |
| Max. Negotiated Rate |
$1,316.65 |
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.60
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Multiplan Commercial |
$1,239.20
|
| Rate for Payer: Networks By Design Commercial |
$1,006.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$778.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$922.89
|
| Rate for Payer: BCBS Transplant Transplant |
$929.40
|
| Rate for Payer: Blue Shield of California Commercial |
$915.46
|
| Rate for Payer: Blue Shield of California EPN |
$726.48
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna of CA HMO |
$991.36
|
| Rate for Payer: Cigna of CA PPO |
$1,146.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,161.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,239.20
|
| Rate for Payer: Networks By Design Commercial |
$1,006.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$929.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$929.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$929.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
IP
|
$14,416.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,459.84 |
| Max. Negotiated Rate |
$12,253.60 |
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,766.40
|
| Rate for Payer: Galaxy Health WC |
$12,253.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,649.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,492.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,459.84
|
| Rate for Payer: Multiplan Commercial |
$11,532.80
|
| Rate for Payer: Networks By Design Commercial |
$9,370.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,253.60
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
OP
|
$14,416.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,328.66 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,649.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cigna of CA PPO |
$10,667.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$12,253.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,649.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,812.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: IEHP Medi-Cal |
$7,002.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,459.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$11,532.80
|
| Rate for Payer: Networks By Design Commercial |
$9,370.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,253.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,649.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,649.60
|
| 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 |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
OP
|
$14,197.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,686.96 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,518.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$6,388.65
|
| Rate for Payer: Cash Price |
$6,388.65
|
| Rate for Payer: Cigna of CA PPO |
$10,505.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$12,067.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,518.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,647.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: IEHP Medi-Cal |
$7,002.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,864.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,407.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$11,357.60
|
| Rate for Payer: Networks By Design Commercial |
$9,228.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,067.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,518.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,518.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
IP
|
$14,197.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,407.28 |
| Max. Negotiated Rate |
$12,067.45 |
| Rate for Payer: Cash Price |
$6,388.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,678.80
|
| Rate for Payer: Galaxy Health WC |
$12,067.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,518.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,409.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,407.28
|
| Rate for Payer: Multiplan Commercial |
$11,357.60
|
| Rate for Payer: Networks By Design Commercial |
$9,228.05
|
| Rate for Payer: Prime Health Services Commercial |
$12,067.45
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
IP
|
$8,126.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,950.24 |
| Max. Negotiated Rate |
$6,907.10 |
| Rate for Payer: Cash Price |
$3,656.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,250.40
|
| Rate for Payer: Galaxy Health WC |
$6,907.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,875.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,420.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,096.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,950.24
|
| Rate for Payer: Multiplan Commercial |
$6,500.80
|
| Rate for Payer: Networks By Design Commercial |
$5,281.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,907.10
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
OP
|
$8,126.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,474.42 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,875.60
|
| 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 |
$3,656.70
|
| Rate for Payer: Cash Price |
$3,656.70
|
| Rate for Payer: Cigna of CA PPO |
$6,013.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$6,907.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,875.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,094.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,418.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,418.05
|
| Rate for Payer: IEHP Medi-Cal |
$2,388.56
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,388.56
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,420.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,693.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,950.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$6,500.80
|
| Rate for Payer: Networks By Design Commercial |
$5,281.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,907.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,875.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,875.60
|
| 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 |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
OP
|
$2,562.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$198.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,177.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,409.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,409.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,526.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1,537.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,514.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,201.58
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna of CA HMO |
$1,639.68
|
| Rate for Payer: Cigna of CA PPO |
$1,895.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,177.70
|
| Rate for Payer: Dignity Health Media |
$2,177.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,177.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,024.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,024.80
|
| Rate for Payer: Galaxy Health WC |
$2,177.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,537.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,921.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,708.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.88
|
| Rate for Payer: Multiplan Commercial |
$2,049.60
|
| Rate for Payer: Networks By Design Commercial |
$1,665.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,177.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,537.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,537.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,537.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,281.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,281.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,281.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,177.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,177.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,177.70
|
|
