|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$154.20
|
| Rate for Payer: Cash Price |
$115.65
|
| Rate for Payer: Cash Price |
$115.65
|
| Rate for Payer: Cash Price |
$115.65
|
| Rate for Payer: Cigna of CA PPO |
$190.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$218.45
|
| Rate for Payer: Global Benefits Group Commercial |
$154.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$192.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$205.60
|
| Rate for Payer: Networks By Design Commercial |
$167.05
|
| Rate for Payer: Prime Health Services Commercial |
$218.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.50
|
| Rate for Payer: United Healthcare All Other HMO |
$128.50
|
| Rate for Payer: United Healthcare HMO Rider |
$128.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$218.45 |
| Rate for Payer: Cash Price |
$115.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.80
|
| Rate for Payer: Galaxy Health WC |
$218.45
|
| Rate for Payer: Global Benefits Group Commercial |
$154.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.68
|
| Rate for Payer: Multiplan Commercial |
$205.60
|
| Rate for Payer: Networks By Design Commercial |
$167.05
|
| Rate for Payer: Prime Health Services Commercial |
$218.45
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$166.08 |
| Max. Negotiated Rate |
$1,834.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$453.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.29
|
| Rate for Payer: Blue Distinction Transplant |
$415.20
|
| Rate for Payer: Blue Shield of California Commercial |
$510.00
|
| Rate for Payer: Blue Shield of California EPN |
$404.13
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna of CA PPO |
$512.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$588.20
|
| Rate for Payer: Global Benefits Group Commercial |
$415.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$519.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$589.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$589.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$461.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$553.60
|
| Rate for Payer: Networks By Design Commercial |
$449.80
|
| Rate for Payer: Prime Health Services Commercial |
$588.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$415.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$415.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$166.08 |
| Max. Negotiated Rate |
$588.20 |
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.80
|
| Rate for Payer: Galaxy Health WC |
$588.20
|
| Rate for Payer: Global Benefits Group Commercial |
$415.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$461.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.08
|
| Rate for Payer: Multiplan Commercial |
$553.60
|
| Rate for Payer: Networks By Design Commercial |
$449.80
|
| Rate for Payer: Prime Health Services Commercial |
$588.20
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.84 |
| Max. Negotiated Rate |
$438.60 |
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.40
|
| Rate for Payer: Galaxy Health WC |
$438.60
|
| Rate for Payer: Global Benefits Group Commercial |
$309.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.84
|
| Rate for Payer: Multiplan Commercial |
$412.80
|
| Rate for Payer: Networks By Design Commercial |
$335.40
|
| Rate for Payer: Prime Health Services Commercial |
$438.60
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.84 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$309.60
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Cash Price |
$232.20
|
| Rate for Payer: Cigna of CA PPO |
$381.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Media |
$196.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$438.60
|
| Rate for Payer: Global Benefits Group Commercial |
$309.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$387.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$322.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$322.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$412.80
|
| Rate for Payer: Networks By Design Commercial |
$335.40
|
| Rate for Payer: Prime Health Services Commercial |
$438.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$309.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.00
|
| Rate for Payer: United Healthcare All Other HMO |
$258.00
|
| Rate for Payer: United Healthcare HMO Rider |
$258.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.48 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.48 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$301.20
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$376.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$251.00
|
| Rate for Payer: United Healthcare HMO Rider |
$251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
IP
|
$1,201.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$1,020.85 |
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.40
|
| Rate for Payer: Galaxy Health WC |
$1,020.85
|
| Rate for Payer: Global Benefits Group Commercial |
$720.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.24
|
| Rate for Payer: Multiplan Commercial |
$960.80
|
| Rate for Payer: Networks By Design Commercial |
$780.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.85
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
OP
|
$1,201.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$1,020.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$787.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$715.56
|
| Rate for Payer: Blue Distinction Transplant |
$720.60
|
| Rate for Payer: Blue Shield of California Commercial |
$885.14
|
| Rate for Payer: Blue Shield of California EPN |
$701.38
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cigna of CA HMO |
$768.64
|
| Rate for Payer: Cigna of CA PPO |
$888.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.85
|
| Rate for Payer: Dignity Health Media |
$1,020.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.40
|
| Rate for Payer: Galaxy Health WC |
$1,020.85
|
| Rate for Payer: Global Benefits Group Commercial |
$720.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$900.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.24
|
| Rate for Payer: Multiplan Commercial |
$960.80
|
| Rate for Payer: Networks By Design Commercial |
$780.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.50
|
| Rate for Payer: United Healthcare All Other HMO |
$600.50
|
| Rate for Payer: United Healthcare HMO Rider |
$600.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$600.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.85
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
IP
|
$1,201.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$1,020.85 |
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.40
|
| Rate for Payer: Galaxy Health WC |
$1,020.85
|
| Rate for Payer: Global Benefits Group Commercial |
$720.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.24
|
| Rate for Payer: Multiplan Commercial |
$960.80
|
| Rate for Payer: Networks By Design Commercial |
$780.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.85
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
OP
|
$1,201.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$1,020.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$787.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$715.56
|
| Rate for Payer: Blue Distinction Transplant |
$720.60
|
| Rate for Payer: Blue Shield of California Commercial |
$885.14
|
| Rate for Payer: Blue Shield of California EPN |
$701.38
|
| Rate for Payer: Cash Price |
$540.45
|
| Rate for Payer: Cigna of CA HMO |
$768.64
|
| Rate for Payer: Cigna of CA PPO |
$888.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.85
|
| Rate for Payer: Dignity Health Media |
$1,020.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.40
|
| Rate for Payer: Galaxy Health WC |
$1,020.85
|
| Rate for Payer: Global Benefits Group Commercial |
$720.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$900.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.24
|
| Rate for Payer: Multiplan Commercial |
$960.80
|
| Rate for Payer: Networks By Design Commercial |
$780.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.50
|
| Rate for Payer: United Healthcare All Other HMO |
$600.50
|
| Rate for Payer: United Healthcare HMO Rider |
$600.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$600.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.85
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$401.28 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.80
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.28
|
| Rate for Payer: Multiplan Commercial |
$1,337.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$486.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.18
|
| Rate for Payer: Blue Distinction Transplant |
$1,003.20
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cigna of CA HMO |
$1,070.08
|
| Rate for Payer: Cigna of CA PPO |
$1,237.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Dignity Health Media |
$873.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,178.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$873.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.10
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,254.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,431.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,431.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,414.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,414.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,100.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,169.95
|
| Rate for Payer: Multiplan Commercial |
$1,337.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,003.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,019.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,309.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.41
|
| Rate for Payer: Vantage Medical Group Senior |
$873.10
|
|
|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
OP
|
$2,527.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$606.48 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,516.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cash Price |
$1,137.15
|
| Rate for Payer: Cigna of CA PPO |
$1,869.98
|
| 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 |
$2,147.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,516.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,895.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,685.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.48
|
| 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 |
$2,021.60
|
| Rate for Payer: Networks By Design Commercial |
$1,642.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,147.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,516.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| 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 UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$907.44 |
| Max. Negotiated Rate |
$3,213.85 |
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,512.40
|
| Rate for Payer: Galaxy Health WC |
$3,213.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,268.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,521.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,440.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$907.44
|
| Rate for Payer: Multiplan Commercial |
$3,024.80
|
| Rate for Payer: Networks By Design Commercial |
$2,457.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,213.85
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$4,653.75 |
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,190.00
|
| Rate for Payer: Galaxy Health WC |
$4,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,285.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,085.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Multiplan Commercial |
$4,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.26 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,285.00
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: Cigna of CA PPO |
$4,051.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,285.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,106.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,737.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,737.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,737.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
IP
|
$9,064.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,175.36 |
| Max. Negotiated Rate |
$7,704.40 |
| Rate for Payer: Cash Price |
$4,078.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,625.60
|
| Rate for Payer: Galaxy Health WC |
$7,704.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,438.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,045.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,453.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,175.36
|
| Rate for Payer: Multiplan Commercial |
$7,251.20
|
| Rate for Payer: Networks By Design Commercial |
$5,891.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,704.40
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
OP
|
$6,057.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,634.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cigna of CA PPO |
$4,482.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Media |
$4,785.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,459.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,785.03
|
| Rate for Payer: Galaxy Health WC |
$5,148.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,634.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,542.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,847.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,847.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,751.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,751.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,040.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,785.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,411.94
|
| Rate for Payer: Multiplan Commercial |
$4,845.60
|
| Rate for Payer: Networks By Design Commercial |
$3,937.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,148.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,742.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$43.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.30
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Media |
$5.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.56
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.45
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
IP
|
$4,037.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$968.88 |
| Max. Negotiated Rate |
$3,431.45 |
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,538.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
OP
|
$4,037.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,220.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,422.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cigna of CA PPO |
$2,987.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Dignity Health Media |
$3,431.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,431.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,614.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,614.80
|
| Rate for Payer: Galaxy Health WC |
$3,431.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,027.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,692.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,997.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.88
|
| Rate for Payer: Multiplan Commercial |
$3,229.60
|
| Rate for Payer: Networks By Design Commercial |
$2,624.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,431.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,422.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,431.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,431.45
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
IP
|
$16,392.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,934.08 |
| Max. Negotiated Rate |
$13,933.20 |
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.80
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,245.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
OP
|
$16,392.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,835.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cash Price |
$7,376.40
|
| Rate for Payer: Cigna of CA PPO |
$12,130.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$13,933.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,835.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,294.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,056.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,933.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,473.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,934.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$13,113.60
|
| Rate for Payer: Networks By Design Commercial |
$10,654.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,933.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
