|
HC TTG IGG
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.45
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.91
|
| Rate for Payer: IEHP Medi-Cal |
$18.68
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$18.68
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
IP
|
$2,926.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$702.24 |
| Max. Negotiated Rate |
$2,487.10 |
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.40
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.24
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
OP
|
$2,926.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$647.96 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,755.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cigna of CA PPO |
$2,165.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$2,487.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| Rate for Payer: IEHP Medi-Cal |
$7,002.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$7,002.64
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,901.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,487.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,755.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC TUBE CHECK (ABSCESS/CYST)
|
Facility
IP
|
$446.00
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
909000212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.04 |
| Max. Negotiated Rate |
$379.10 |
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.40
|
| Rate for Payer: Galaxy Health WC |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.04
|
| Rate for Payer: Multiplan Commercial |
$356.80
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
|
|
HC TUBE CHECK (ABSCESS/CYST)
|
Facility
OP
|
$446.00
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
909000212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.91 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$379.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$245.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$245.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$267.60
|
| 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 |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna of CA PPO |
$330.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$379.10
|
| Rate for Payer: Dignity Health Media |
$379.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$379.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$178.40
|
| Rate for Payer: Galaxy Health WC |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$334.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.04
|
| Rate for Payer: Multiplan Commercial |
$356.80
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$267.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.60
|
| 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 |
$379.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$379.10
|
| Rate for Payer: Vantage Medical Group Senior |
$379.10
|
|
|
HC TUBE ENDOTRACH 5.5MM W/CUFF
|
Facility
IP
|
$31.16
|
|
| Hospital Charge Code |
901698781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE ENDOTRACH 5.5MM W/CUFF
|
Facility
OP
|
$31.16
|
|
| Hospital Charge Code |
901698781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.57
|
| Rate for Payer: BCBS Transplant Transplant |
$18.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.96
|
| Rate for Payer: Blue Shield of California EPN |
$18.20
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Media |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUBE ENDOTRACH 6.0MM W/CUFF
|
Facility
OP
|
$15.58
|
|
| Hospital Charge Code |
901698797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.28
|
| Rate for Payer: BCBS Transplant Transplant |
$9.35
|
| Rate for Payer: Blue Shield of California Commercial |
$11.48
|
| Rate for Payer: Blue Shield of California EPN |
$9.10
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cigna of CA HMO |
$9.97
|
| Rate for Payer: Cigna of CA PPO |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.24
|
| Rate for Payer: Dignity Health Media |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.79
|
| Rate for Payer: United Healthcare All Other HMO |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC TUBE ENDOTRACH 6.0MM W/CUFF
|
Facility
IP
|
$15.58
|
|
| Hospital Charge Code |
901698797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
|
|
HC TUBE ENDOTRACH 6.5MM W/CUFF
|
Facility
IP
|
$31.16
|
|
| Hospital Charge Code |
901698788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE ENDOTRACH 6.5MM W/CUFF
|
Facility
OP
|
$31.16
|
|
| Hospital Charge Code |
901698788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.57
|
| Rate for Payer: BCBS Transplant Transplant |
$18.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.96
|
| Rate for Payer: Blue Shield of California EPN |
$18.20
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Media |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUBE ENDOTRACH 8.5MM W/CUFF
|
Facility
OP
|
$15.58
|
|
| Hospital Charge Code |
901698773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.28
|
| Rate for Payer: BCBS Transplant Transplant |
$9.35
|
| Rate for Payer: Blue Shield of California Commercial |
$11.48
|
| Rate for Payer: Blue Shield of California EPN |
$9.10
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cigna of CA HMO |
$9.97
|
| Rate for Payer: Cigna of CA PPO |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.24
|
| Rate for Payer: Dignity Health Media |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.79
|
| Rate for Payer: United Healthcare All Other HMO |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC TUBE ENDOTRACH 8.5MM W/CUFF
|
Facility
IP
|
$15.58
|
|
| Hospital Charge Code |
901698773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
|
|
HC TUBE GASTROSTOMY 16FR 3-5ML
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$115.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.98
|
| Rate for Payer: BCBS Transplant Transplant |
$31.20
|
| Rate for Payer: Blue Shield of California Commercial |
$38.32
|
| Rate for Payer: Blue Shield of California EPN |
$30.37
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Media |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26.00
|
| Rate for Payer: United Healthcare HMO Rider |
$26.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC TUBE GASTROSTOMY 16FR 3-5ML
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC TUBE GASTROSTOMY 18FR 3-PORT
|
Facility
OP
|
$243.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.78
|
| Rate for Payer: BCBS Transplant Transplant |
$145.80
|
| Rate for Payer: Blue Shield of California Commercial |
$179.09
|
| Rate for Payer: Blue Shield of California EPN |
$141.91
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$155.52
|
| Rate for Payer: Cigna of CA PPO |
$179.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Media |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$182.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.50
|
| Rate for Payer: United Healthcare All Other HMO |
$121.50
|
| Rate for Payer: United Healthcare HMO Rider |
$121.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC TUBE GASTROSTOMY 18FR 3-PORT
|
Facility
IP
|
$243.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
|
|
HC TUBE GASTROSTOMY 22FR 7-10ML
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: BCBS Transplant Transplant |
$134.40
|
| Rate for Payer: Blue Shield of California Commercial |
$165.09
|
| Rate for Payer: Blue Shield of California EPN |
$130.82
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$143.36
|
| Rate for Payer: Cigna of CA PPO |
$165.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Media |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.00
|
| Rate for Payer: United Healthcare All Other HMO |
$112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$112.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC TUBE GASTROSTOMY 22FR 7-10ML
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
OP
|
$114.91
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.58 |
| Max. Negotiated Rate |
$97.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$97.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$63.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$63.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.46
|
| Rate for Payer: BCBS Transplant Transplant |
$68.95
|
| Rate for Payer: Blue Shield of California Commercial |
$84.69
|
| Rate for Payer: Blue Shield of California EPN |
$67.11
|
| Rate for Payer: Cash Price |
$51.71
|
| Rate for Payer: Cash Price |
$51.71
|
| Rate for Payer: Cigna of CA HMO |
$73.54
|
| Rate for Payer: Cigna of CA PPO |
$85.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.67
|
| Rate for Payer: Dignity Health Media |
$97.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.96
|
| Rate for Payer: Galaxy Health WC |
$97.67
|
| Rate for Payer: Global Benefits Group Commercial |
$68.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.58
|
| Rate for Payer: Multiplan Commercial |
$91.93
|
| Rate for Payer: Networks By Design Commercial |
$74.69
|
| Rate for Payer: Prime Health Services Commercial |
$97.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$68.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.46
|
| Rate for Payer: United Healthcare All Other HMO |
$57.46
|
| Rate for Payer: United Healthcare HMO Rider |
$57.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.67
|
| Rate for Payer: Vantage Medical Group Senior |
$97.67
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
IP
|
$114.91
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.58 |
| Max. Negotiated Rate |
$97.67 |
| Rate for Payer: Cash Price |
$51.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.96
|
| Rate for Payer: Galaxy Health WC |
$97.67
|
| Rate for Payer: Global Benefits Group Commercial |
$68.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.58
|
| Rate for Payer: Multiplan Commercial |
$91.93
|
| Rate for Payer: Networks By Design Commercial |
$74.69
|
| Rate for Payer: Prime Health Services Commercial |
$97.67
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
IP
|
$1,279.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.96 |
| Max. Negotiated Rate |
$1,087.15 |
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.96
|
| Rate for Payer: Multiplan Commercial |
$1,023.20
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
OP
|
$1,279.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.04 |
| Max. Negotiated Rate |
$1,087.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$513.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$703.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$703.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.02
|
| Rate for Payer: BCBS Transplant Transplant |
$767.40
|
| Rate for Payer: Blue Shield of California Commercial |
$755.89
|
| Rate for Payer: Blue Shield of California EPN |
$599.85
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cigna of CA HMO |
$818.56
|
| Rate for Payer: Cigna of CA PPO |
$946.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Dignity Health Media |
$1,087.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,087.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$959.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.96
|
| Rate for Payer: Multiplan Commercial |
$1,023.20
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$767.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$767.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$767.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.50
|
| Rate for Payer: United Healthcare All Other HMO |
$639.50
|
| Rate for Payer: United Healthcare HMO Rider |
$639.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$639.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,087.15
|
|
|
HC TUBE THORACOSTOMY
|
Facility
OP
|
$3,863.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.70 |
| 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 |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,317.80
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cigna of CA PPO |
$2,858.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,897.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$3,090.40
|
| Rate for Payer: Networks By Design Commercial |
$2,510.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,317.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,317.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,931.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,931.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,931.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC TUBE THORACOSTOMY
|
Facility
IP
|
$3,863.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$927.12 |
| Max. Negotiated Rate |
$3,283.55 |
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,471.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.12
|
| Rate for Payer: Multiplan Commercial |
$3,090.40
|
| Rate for Payer: Networks By Design Commercial |
$2,510.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
|
