|
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
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
IP
|
$2,953.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$708.72 |
| Max. Negotiated Rate |
$2,510.05 |
| Rate for Payer: Cash Price |
$1,328.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,181.20
|
| Rate for Payer: Galaxy Health WC |
$2,510.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,771.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,969.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,125.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$708.72
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: Networks By Design Commercial |
$1,919.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,510.05
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
OP
|
$2,953.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,731.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,771.80
|
| 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 |
$1,328.85
|
| Rate for Payer: Cash Price |
$1,328.85
|
| Rate for Payer: Cigna of CA PPO |
$2,185.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Dignity Health Media |
$1,731.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,904.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,337.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,731.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,731.24
|
| Rate for Payer: Galaxy Health WC |
$2,510.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,771.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,214.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,839.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,839.23
|
| Rate for Payer: IEHP Medi-Cal |
$2,804.61
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,804.61
|
| Rate for Payer: IEHP Medicare Advantage |
$1,731.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,969.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,731.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$708.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,181.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,319.86
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: Networks By Design Commercial |
$1,919.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,510.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,771.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,771.80
|
| 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 |
$2,596.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.24
|
|
|
HC PERC PULM ART STENT ABN UNI
|
Facility
OP
|
$47,756.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906811902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$28,653.60
|
| 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 |
$21,490.20
|
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: Cigna of CA PPO |
$35,339.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Media |
$21,908.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,577.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21,908.96
|
| Rate for Payer: Galaxy Health WC |
$40,592.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28,653.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35,817.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,930.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$35,930.69
|
| Rate for Payer: IEHP Medi-Cal |
$35,492.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$35,492.52
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,853.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,908.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,461.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,358.01
|
| Rate for Payer: Multiplan Commercial |
$38,204.80
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: Networks By Design Commercial |
$31,041.40
|
| Rate for Payer: Prime Health Services Commercial |
$40,592.60
|
| Rate for Payer: Prime Health Services WC |
$29,647.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28,653.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,653.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERC PULM ART STENT ABN UNI
|
Facility
IP
|
$47,756.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906811902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,461.44 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,102.40
|
| Rate for Payer: Galaxy Health WC |
$40,592.60
|
| Rate for Payer: Global Benefits Group Commercial |
$28,653.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,853.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,195.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,461.44
|
| Rate for Payer: Multiplan Commercial |
$38,204.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$40,592.60
|
|
|
HC PERC RF ABLATION, LUNG
|
Facility
OP
|
$16,983.00
|
|
|
Service Code
|
CPT 32998
|
| Hospital Charge Code |
909081840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,351.09 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,189.80
|
| 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 |
$7,642.35
|
| Rate for Payer: Cash Price |
$7,642.35
|
| Rate for Payer: Cigna of CA PPO |
$12,567.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$14,435.55
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,737.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: IEHP Medi-Cal |
$11,678.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,327.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,920.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,075.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$13,586.40
|
| Rate for Payer: Networks By Design Commercial |
$11,038.95
|
| Rate for Payer: Prime Health Services Commercial |
$14,435.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,189.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,189.80
|
| 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 |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC PERC RF ABLATION, LUNG
|
Facility
IP
|
$16,983.00
|
|
|
Service Code
|
CPT 32998
|
| Hospital Charge Code |
909081840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,075.92 |
| Max. Negotiated Rate |
$14,435.55 |
| Rate for Payer: Cash Price |
$7,642.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,793.20
|
| Rate for Payer: Galaxy Health WC |
$14,435.55
|
| Rate for Payer: Global Benefits Group Commercial |
$10,189.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,327.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,470.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,075.92
|
| Rate for Payer: Multiplan Commercial |
$13,586.40
|
| Rate for Payer: Networks By Design Commercial |
$11,038.95
|
| Rate for Payer: Prime Health Services Commercial |
$14,435.55
|
|
|
HC PERC RF ABLATION, RENAL TUMOR
|
Facility
IP
|
$22,189.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
909081854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,325.36 |
| Max. Negotiated Rate |
$18,860.65 |
| Rate for Payer: Cash Price |
$9,985.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,875.60
|
| Rate for Payer: Galaxy Health WC |
$18,860.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,313.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,800.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,325.36
|
| Rate for Payer: Multiplan Commercial |
$17,751.20
|
| Rate for Payer: Networks By Design Commercial |
$14,422.85
|
| Rate for Payer: Prime Health Services Commercial |
$18,860.65
|
|
|
HC PERC RF ABLATION, RENAL TUMOR
|
Facility
OP
|
$22,189.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
909081854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,777.25 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13,313.40
|
| 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 |
$9,985.05
|
| Rate for Payer: Cash Price |
$9,985.05
|
| Rate for Payer: Cigna of CA PPO |
$16,419.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$18,860.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,313.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16,641.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,823.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,823.10
|
| Rate for Payer: IEHP Medi-Cal |
$11,678.92
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,678.92
|
| Rate for Payer: IEHP Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,800.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,325.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$17,751.20
|
| Rate for Payer: Networks By Design Commercial |
$14,422.85
|
| Rate for Payer: Prime Health Services Commercial |
$18,860.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13,313.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,313.40
|
| 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 |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC PERC SKEL FIX OF FEM FRAC
|
Facility
IP
|
$8,236.00
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
900501086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,976.64 |
| Max. Negotiated Rate |
$7,000.60 |
| Rate for Payer: Blue Shield of California Commercial |
$5,864.03
|
| Rate for Payer: Blue Shield of California EPN |
$4,216.83
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,294.40
|
| Rate for Payer: Galaxy Health WC |
$7,000.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,941.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,493.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,137.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,976.64
|
| Rate for Payer: Multiplan Commercial |
$6,588.80
|
| Rate for Payer: Networks By Design Commercial |
$5,353.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,000.60
|
|
|
HC PERC SKEL FIX OF FEM FRAC
|
Facility
OP
|
$8,236.00
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
900501086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,941.60
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cigna of CA PPO |
$6,094.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$7,000.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,941.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,177.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,493.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,976.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$6,588.80
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$5,353.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,000.60
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,941.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,941.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,118.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,118.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,118.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,118.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
IP
|
$5,654.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,356.96 |
| Max. Negotiated Rate |
$4,805.90 |
| Rate for Payer: Cash Price |
$2,544.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,261.60
|
| Rate for Payer: Galaxy Health WC |
$4,805.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,392.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,771.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,154.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.96
|
| Rate for Payer: Multiplan Commercial |
$4,523.20
|
| Rate for Payer: Networks By Design Commercial |
$3,675.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,805.90
|
|
|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
OP
|
$5,654.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,392.40
|
| Rate for Payer: Cash Price |
$2,544.30
|
| Rate for Payer: Cash Price |
$2,544.30
|
| Rate for Payer: Cash Price |
$2,544.30
|
| Rate for Payer: Cigna of CA PPO |
$4,183.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$4,805.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,392.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,240.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,771.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$4,523.20
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$3,675.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,805.90
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,392.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,827.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,827.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,827.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
IP
|
$17,052.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,092.48 |
| Max. Negotiated Rate |
$14,494.20 |
| Rate for Payer: Cash Price |
$7,673.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,820.80
|
| Rate for Payer: Galaxy Health WC |
$14,494.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,496.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,092.48
|
| Rate for Payer: Multiplan Commercial |
$13,641.60
|
| Rate for Payer: Networks By Design Commercial |
$11,083.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,494.20
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
OP
|
$17,052.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,075.64 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,231.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$7,673.40
|
| Rate for Payer: Cash Price |
$7,673.40
|
| Rate for Payer: Cigna of CA PPO |
$12,618.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$14,494.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,789.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,711.81
|
| Rate for Payer: IEHP Medi-Cal |
$11,568.99
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$11,568.99
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,075.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,092.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$13,641.60
|
| Rate for Payer: Networks By Design Commercial |
$11,083.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,494.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,231.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,231.20
|
| 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 |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
OP
|
$6,983.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,675.92 |
| 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 |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,189.80
|
| 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 |
$3,142.35
|
| Rate for Payer: Cash Price |
$3,142.35
|
| Rate for Payer: Cigna of CA PPO |
$5,167.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$5,935.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,189.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,237.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: IEHP Medi-Cal |
$3,851.47
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,657.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,078.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,675.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$5,586.40
|
| Rate for Payer: Networks By Design Commercial |
$4,538.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,935.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,189.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,189.80
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
IP
|
$6,983.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,675.92 |
| Max. Negotiated Rate |
$5,935.55 |
| Rate for Payer: Cash Price |
$3,142.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,793.20
|
| Rate for Payer: Galaxy Health WC |
$5,935.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,189.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,657.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,660.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,675.92
|
| Rate for Payer: Multiplan Commercial |
$5,586.40
|
| Rate for Payer: Networks By Design Commercial |
$4,538.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,935.55
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
IP
|
$7,730.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,855.20 |
| Max. Negotiated Rate |
$6,570.50 |
| Rate for Payer: Cash Price |
$3,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,092.00
|
| Rate for Payer: Galaxy Health WC |
$6,570.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,945.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.20
|
| Rate for Payer: Multiplan Commercial |
$6,184.00
|
| Rate for Payer: Networks By Design Commercial |
$5,024.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,570.50
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
OP
|
$7,730.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$6,570.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$977.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.13
|
| Rate for Payer: BCBS Transplant Transplant |
$4,638.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,568.43
|
| Rate for Payer: Blue Shield of California EPN |
$3,625.37
|
| Rate for Payer: Cash Price |
$3,478.50
|
| Rate for Payer: Cash Price |
$3,478.50
|
| Rate for Payer: Cigna of CA HMO |
$4,947.20
|
| Rate for Payer: Cigna of CA PPO |
$5,720.20
|
| 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 |
$6,570.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,638.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,797.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.20
|
| 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 |
$6,184.00
|
| Rate for Payer: Networks By Design Commercial |
$5,024.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,570.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,638.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| 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 PERC TRANSPORTAL W/O HEMO
|
Facility
IP
|
$3,554.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$852.96 |
| Max. Negotiated Rate |
$3,020.90 |
| Rate for Payer: Cash Price |
$1,599.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,421.60
|
| Rate for Payer: Galaxy Health WC |
$3,020.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,132.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,370.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,354.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.96
|
| Rate for Payer: Multiplan Commercial |
$2,843.20
|
| Rate for Payer: Networks By Design Commercial |
$2,310.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.90
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
OP
|
$3,554.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$852.96 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$992.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.13
|
| Rate for Payer: BCBS Transplant Transplant |
$2,132.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,100.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,666.83
|
| Rate for Payer: Cash Price |
$1,599.30
|
| Rate for Payer: Cash Price |
$1,599.30
|
| Rate for Payer: Cigna of CA HMO |
$2,274.56
|
| Rate for Payer: Cigna of CA PPO |
$2,629.96
|
| 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 |
$3,020.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,132.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,665.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: IEHP Medi-Cal |
$6,451.73
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,370.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.96
|
| 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 |
$2,843.20
|
| Rate for Payer: Networks By Design Commercial |
$2,310.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,132.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,132.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,132.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| 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 PERC TRLUML ANGP NAT/RECR COA
|
Facility
IP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,381.36 |
| Max. Negotiated Rate |
$22,600.65 |
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,635.60
|
| Rate for Payer: Galaxy Health WC |
$22,600.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,953.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,734.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,130.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,381.36
|
| Rate for Payer: Multiplan Commercial |
$21,271.20
|
| Rate for Payer: Networks By Design Commercial |
$17,282.85
|
| Rate for Payer: Prime Health Services Commercial |
$22,600.65
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
OP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.09 |
| Max. Negotiated Rate |
$22,600.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,583.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22,600.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,623.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14,623.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: BCBS Transplant Transplant |
$15,953.40
|
| 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 |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cigna of CA PPO |
$19,675.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,600.65
|
| Rate for Payer: Dignity Health Media |
$22,600.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,600.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,635.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,635.60
|
| Rate for Payer: Galaxy Health WC |
$22,600.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,953.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19,941.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,734.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,381.36
|
| Rate for Payer: Multiplan Commercial |
$21,271.20
|
| Rate for Payer: Networks By Design Commercial |
$17,282.85
|
| Rate for Payer: Prime Health Services Commercial |
$22,600.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15,953.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,953.40
|
| 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 |
$22,600.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,600.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22,600.65
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
OP
|
$14,328.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,429.00 |
| Max. Negotiated Rate |
$12,178.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,178.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,880.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,880.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,536.62
|
| Rate for Payer: BCBS Transplant Transplant |
$8,596.80
|
| 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 |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cigna of CA PPO |
$10,602.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Dignity Health Media |
$12,178.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,178.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,731.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,731.20
|
| Rate for Payer: Galaxy Health WC |
$12,178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,596.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,746.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,556.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,438.72
|
| Rate for Payer: Multiplan Commercial |
$11,462.40
|
| Rate for Payer: Networks By Design Commercial |
$9,313.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,178.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,596.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,596.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,164.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,164.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,164.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,164.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,178.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,178.80
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
IP
|
$14,328.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,438.72 |
| Max. Negotiated Rate |
$12,178.80 |
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,731.20
|
| Rate for Payer: Galaxy Health WC |
$12,178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,596.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,556.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,458.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,438.72
|
| Rate for Payer: Multiplan Commercial |
$11,462.40
|
| Rate for Payer: Networks By Design Commercial |
$9,313.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,178.80
|
|
