|
HC EMBOLIZATION FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
IP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Cash Price |
$2,418.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,759.00
|
| Rate for Payer: Galaxy Health WC |
$3,737.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,722.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.40
|
| Rate for Payer: Multiplan Commercial |
$3,518.00
|
| Rate for Payer: Networks By Design Commercial |
$2,858.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.88
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
OP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,884.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,418.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,298.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,700.50
|
| Rate for Payer: Cash Price |
$2,418.62
|
| Rate for Payer: Cigna of CA HMO |
$2,814.40
|
| Rate for Payer: Cigna of CA PPO |
$3,254.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,737.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,737.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,759.00
|
| Rate for Payer: Galaxy Health WC |
$3,737.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,722.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,078.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,078.25
|
| Rate for Payer: Multiplan Commercial |
$3,518.00
|
| Rate for Payer: Networks By Design Commercial |
$2,858.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,638.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,638.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,198.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,198.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,198.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,737.88
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
IP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Cigna of CA HMO |
$785.68
|
| Rate for Payer: Cigna of CA PPO |
$785.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.96
|
| Rate for Payer: EPIC Health Plan Senior |
$448.96
|
| Rate for Payer: Galaxy Health WC |
$954.04
|
| Rate for Payer: Global Benefits Group Commercial |
$673.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.38
|
| Rate for Payer: Multiplan Commercial |
$897.92
|
| Rate for Payer: Networks By Design Commercial |
$561.20
|
| Rate for Payer: Prime Health Services Commercial |
$954.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.24
|
| Rate for Payer: United Healthcare All Other HMO |
$410.01
|
| Rate for Payer: United Healthcare HMO Rider |
$401.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.59
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
OP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$954.04 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.09
|
| Rate for Payer: Blue Shield of California Commercial |
$828.33
|
| Rate for Payer: Blue Shield of California EPN |
$545.49
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Cigna of CA HMO |
$785.68
|
| Rate for Payer: Cigna of CA PPO |
$785.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$954.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$954.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$954.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.96
|
| Rate for Payer: EPIC Health Plan Senior |
$448.96
|
| Rate for Payer: Galaxy Health WC |
$954.04
|
| Rate for Payer: Global Benefits Group Commercial |
$673.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$785.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$785.68
|
| Rate for Payer: Multiplan Commercial |
$897.92
|
| Rate for Payer: Networks By Design Commercial |
$561.20
|
| Rate for Payer: Prime Health Services Commercial |
$954.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.24
|
| Rate for Payer: United Healthcare All Other HMO |
$410.01
|
| Rate for Payer: United Healthcare HMO Rider |
$401.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$954.04
|
| Rate for Payer: Vantage Medical Group Senior |
$954.04
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
IP
|
$6,914.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$5,876.90 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,634.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.36
|
| Rate for Payer: Multiplan Commercial |
$5,531.20
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
OP
|
$6,914.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,802.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,185.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: Cigna of CA HMO |
$4,424.96
|
| Rate for Payer: Cigna of CA PPO |
$5,116.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,876.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,876.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,402.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,585.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,839.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,839.80
|
| Rate for Payer: Multiplan Commercial |
$5,531.20
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,876.90
|
|
|
HC EM EMBED ONLY
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$507.45 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$391.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.62
|
| Rate for Payer: Blue Shield of California Commercial |
$399.39
|
| Rate for Payer: Blue Shield of California EPN |
$263.87
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Cigna of CA HMO |
$382.08
|
| Rate for Payer: Cigna of CA PPO |
$441.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC EM EMBED ONLY
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$507.45 |
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.28
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
|
|
HC END ABL THY INC VEIN 1ST VEIN
|
Facility
|
IP
|
$11,447.00
|
|
|
Service Code
|
CPT 36482
|
| Hospital Charge Code |
909026482
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,289.40 |
| Max. Negotiated Rate |
$9,729.95 |
| Rate for Payer: Adventist Health Commercial |
$2,289.40
|
| Rate for Payer: Cash Price |
$6,295.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,578.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,578.80
|
| Rate for Payer: Galaxy Health WC |
$9,729.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,868.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,635.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,361.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,085.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,747.28
|
| Rate for Payer: Multiplan Commercial |
$9,157.60
|
| Rate for Payer: Networks By Design Commercial |
$7,440.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,729.95
|
|
|
HC END ABL THY INC VEIN 1ST VEIN
|
Facility
|
OP
|
$11,447.00
|
|
|
Service Code
|
CPT 36482
|
| Hospital Charge Code |
909026482
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,289.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,289.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$6,295.85
|
| Rate for Payer: Cash Price |
$6,295.85
|
| Rate for Payer: Cash Price |
$6,295.85
|
| Rate for Payer: Cigna of CA HMO |
$7,326.08
|
| Rate for Payer: Cigna of CA PPO |
$8,470.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$9,729.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,868.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,307.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,635.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,740.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,747.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$9,157.60
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$7,440.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,729.95
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,868.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$2,771.00 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Cash Price |
$1,793.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,174.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,242.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,017.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$652.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,793.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,445.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,793.00
|
| Rate for Payer: Cash Price |
$1,793.00
|
| Rate for Payer: Cash Price |
$1,793.00
|
| Rate for Payer: Cigna of CA HMO |
$2,086.40
|
| Rate for Payer: Cigna of CA PPO |
$2,412.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,771.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,771.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,304.00
|
| Rate for Payer: Galaxy Health WC |
$2,771.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,956.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$807.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,174.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$913.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,017.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,282.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,282.00
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: Networks By Design Commercial |
$2,119.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,771.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,956.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,771.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,771.00
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$275.86 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cigna of CA HMO |
$1,354.24
|
| Rate for Payer: Cigna of CA PPO |
$1,565.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,217.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,106.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1,106.36
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,814.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,394.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,482.52
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: Prime Health Services WC |
$1,744.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,269.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,058.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,058.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,058.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,058.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,106.36
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$1,798.60 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$806.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,309.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
IP
|
$3,861.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$772.20 |
| Max. Negotiated Rate |
$3,281.85 |
| Rate for Payer: Adventist Health Commercial |
$772.20
|
| Rate for Payer: Cash Price |
$2,123.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,544.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,544.40
|
| Rate for Payer: Galaxy Health WC |
$3,281.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,316.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,575.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,471.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,389.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$3,088.80
|
| Rate for Payer: Networks By Design Commercial |
$2,509.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,281.85
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
OP
|
$3,861.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$204.52 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$772.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,123.55
|
| Rate for Payer: Cash Price |
$2,123.55
|
| Rate for Payer: Cash Price |
$2,123.55
|
| Rate for Payer: Cigna of CA HMO |
$2,471.04
|
| Rate for Payer: Cigna of CA PPO |
$2,857.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$3,281.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,316.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$204.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,575.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$926.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$3,088.80
|
| Rate for Payer: Networks By Design Commercial |
$2,509.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,281.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,316.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$202.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$617.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,698.95
|
| Rate for Payer: Cash Price |
$1,698.95
|
| Rate for Payer: Cash Price |
$1,698.95
|
| Rate for Payer: Cigna of CA HMO |
$1,976.96
|
| Rate for Payer: Cigna of CA PPO |
$2,285.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,625.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,853.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,060.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,471.20
|
| Rate for Payer: Networks By Design Commercial |
$2,007.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,625.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,853.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$617.80 |
| Max. Negotiated Rate |
$2,625.65 |
| Rate for Payer: Adventist Health Commercial |
$617.80
|
| Rate for Payer: Cash Price |
$1,698.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,235.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,235.60
|
| Rate for Payer: Galaxy Health WC |
$2,625.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,853.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,060.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,176.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,912.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.36
|
| Rate for Payer: Multiplan Commercial |
$2,471.20
|
| Rate for Payer: Networks By Design Commercial |
$2,007.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,625.65
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$479.50
|
| Rate for Payer: United Healthcare All Other HMO |
$479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$479.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$479.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.98 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$753.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$487.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$665.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$487.85
|
| Rate for Payer: Cash Price |
$487.85
|
| Rate for Payer: Cash Price |
$487.85
|
| Rate for Payer: Cigna of CA HMO |
$567.68
|
| Rate for Payer: Cigna of CA PPO |
$656.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$753.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$753.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$753.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,055.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,325.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$549.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$620.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$620.90
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$753.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$753.95
|
| Rate for Payer: Vantage Medical Group Senior |
$753.95
|
|
|
HC ENDOLUMINAL BX BILIARY TREE
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
909047543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$753.95 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Cash Price |
$487.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$549.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.88
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
|
