|
HC BILIARY ENDSCPY, INTRAOP
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT 47550
|
| Hospital Charge Code |
909047550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$835.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,840.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,280.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA PPO |
$6,512.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Media |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,600.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,080.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.20
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$5,720.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,520.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC BILIARY ENDSCPY, PERC; W RMVL OF CLCLS
|
Facility
|
IP
|
$15,253.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
909047554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,050.60 |
| Max. Negotiated Rate |
$13,727.70 |
| Rate for Payer: Cash Price |
$6,863.85
|
| Rate for Payer: Central Health Plan Commercial |
$12,202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,101.20
|
| Rate for Payer: Galaxy Health WC |
$12,965.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,727.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,811.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,050.60
|
| Rate for Payer: Multiplan Commercial |
$11,439.75
|
| Rate for Payer: Networks By Design Commercial |
$9,914.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,965.05
|
|
|
HC BILIARY ENDSCPY, PERC; W RMVL OF CLCLS
|
Facility
|
OP
|
$15,253.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
909047554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.50 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,861.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$17,583.26
|
| Rate for Payer: Blue Distinction Transplant |
$9,151.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$12,861.31
|
| Rate for Payer: Cash Price |
$6,863.85
|
| Rate for Payer: Cash Price |
$6,863.85
|
| Rate for Payer: Central Health Plan Commercial |
$12,202.40
|
| Rate for Payer: Cigna of CA PPO |
$11,287.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Media |
$12,861.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,362.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,861.31
|
| Rate for Payer: Galaxy Health WC |
$12,965.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,727.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,439.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,092.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,221.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: InnovAge PACE Commercial |
$19,291.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,861.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,050.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,234.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,234.16
|
| Rate for Payer: Multiplan Commercial |
$11,439.75
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: Networks By Design Commercial |
$9,914.45
|
| Rate for Payer: Preferred Health Network WC |
$17,942.10
|
| Rate for Payer: Prime Health Services Commercial |
$12,965.05
|
| Rate for Payer: Prime Health Services Medicare |
$13,632.99
|
| Rate for Payer: Prime Health Services WC |
$17,403.84
|
| Rate for Payer: Riverside University Health System MISP |
$14,147.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
OP
|
$18,314.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,209.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,988.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$7,209.21
|
| Rate for Payer: Cash Price |
$8,241.30
|
| Rate for Payer: Cash Price |
$8,241.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,651.20
|
| Rate for Payer: Cigna of CA PPO |
$13,552.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$15,566.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,988.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,482.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,735.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,823.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,895.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: InnovAge PACE Commercial |
$10,813.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,960.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,662.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,660.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$13,735.50
|
| Rate for Payer: Networks By Design Commercial |
$11,904.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,566.90
|
| Rate for Payer: Prime Health Services Medicare |
$7,641.76
|
| Rate for Payer: Riverside University Health System MISP |
$7,930.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,988.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BILIARY STNT PLCMNT EXT ACCESS
|
Facility
|
IP
|
$18,314.00
|
|
|
Service Code
|
CPT 47538
|
| Hospital Charge Code |
909047538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,662.80 |
| Max. Negotiated Rate |
$16,482.60 |
| Rate for Payer: Cash Price |
$8,241.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,651.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,325.60
|
| Rate for Payer: Galaxy Health WC |
$15,566.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,988.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,482.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,977.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,662.80
|
| Rate for Payer: Multiplan Commercial |
$13,735.50
|
| Rate for Payer: Networks By Design Commercial |
$11,904.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,566.90
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
IP
|
$12,630.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,526.00 |
| Max. Negotiated Rate |
$11,367.00 |
| Rate for Payer: Cash Price |
$5,683.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,052.00
|
| Rate for Payer: Galaxy Health WC |
$10,735.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,578.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,367.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,812.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.00
|
| Rate for Payer: Multiplan Commercial |
$9,472.50
|
| Rate for Payer: Networks By Design Commercial |
$8,209.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,735.50
|
|
|
HC BILIARY STONE REMVL T-TUBE
|
Facility
|
OP
|
$12,630.00
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
909000151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$11,367.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,946.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,946.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,578.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Cash Price |
$5,683.50
|
| Rate for Payer: Cash Price |
$5,683.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,104.00
|
| Rate for Payer: Cigna of CA PPO |
$9,346.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.50
|
| Rate for Payer: Dignity Health Media |
$10,735.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,052.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,052.00
|
| Rate for Payer: Galaxy Health WC |
$10,735.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,578.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,367.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,472.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,420.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.00
|
| Rate for Payer: Multiplan Commercial |
$9,472.50
|
| Rate for Payer: Networks By Design Commercial |
$8,209.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,735.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,052.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,578.00
|
| 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 Medi-Cal |
$10,735.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,735.50
|
|
|
HC BILIARY TRACT CELLVIZIO
|
Facility
|
OP
|
$6,023.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,657.77
|
| 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 Exchange |
$2,916.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,558.39
|
| Rate for Payer: Blue Distinction Transplant |
$3,613.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$2,710.35
|
| Rate for Payer: Cash Price |
$2,710.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,818.40
|
| Rate for Payer: Cigna of CA PPO |
$4,457.02
|
| 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 |
$5,119.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,613.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,420.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,517.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,017.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,517.25
|
| Rate for Payer: Networks By Design Commercial |
$3,914.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,119.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,613.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| 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 |
$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 BILIARY TRACT CELLVIZIO
|
Facility
|
IP
|
$9,093.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
906747999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,818.60 |
| Max. Negotiated Rate |
$8,183.70 |
| Rate for Payer: Cash Price |
$4,091.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,637.20
|
| Rate for Payer: Galaxy Health WC |
$7,729.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,455.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,183.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,464.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,818.60
|
| Rate for Payer: Multiplan Commercial |
$6,819.75
|
| Rate for Payer: Networks By Design Commercial |
$5,910.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,729.05
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
OP
|
$7,607.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,423.23 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,322.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,564.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Cash Price |
$3,423.15
|
| Rate for Payer: Cash Price |
$3,423.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,085.60
|
| Rate for Payer: Cigna of CA PPO |
$5,629.18
|
| 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 |
$6,465.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,846.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,705.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,132.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: InnovAge PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,423.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$5,705.25
|
| Rate for Payer: Networks By Design Commercial |
$4,944.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,465.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,754.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,564.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC BILIARY TUBE CK-CHOLANGIO
|
Facility
|
IP
|
$7,607.00
|
|
|
Service Code
|
CPT 47532
|
| Hospital Charge Code |
909000144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,521.40 |
| Max. Negotiated Rate |
$6,846.30 |
| Rate for Payer: Cash Price |
$3,423.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,085.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,042.80
|
| Rate for Payer: Galaxy Health WC |
$6,465.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,564.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,846.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,073.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,898.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.40
|
| Rate for Payer: Multiplan Commercial |
$5,705.25
|
| Rate for Payer: Networks By Design Commercial |
$4,944.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,465.95
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
OP
|
$2,208.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.12 |
| Max. Negotiated Rate |
$1,987.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$460.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,876.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,214.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,214.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,263.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,540.58
|
| Rate for Payer: Blue Distinction Transplant |
$1,324.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,364.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.09
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,766.40
|
| Rate for Payer: Cigna of CA HMO |
$1,413.12
|
| Rate for Payer: Cigna of CA PPO |
$1,633.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,876.80
|
| Rate for Payer: Dignity Health Media |
$1,876.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$883.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$883.20
|
| Rate for Payer: Galaxy Health WC |
$1,876.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,987.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,656.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$772.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,472.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,435.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,876.80
|
| Rate for Payer: Riverside University Health System MISP |
$883.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,324.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,324.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,104.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,104.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,104.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,876.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,876.80
|
|
|
HC BILI DUCT DILITATION PERC
|
Facility
|
IP
|
$2,208.00
|
|
|
Service Code
|
CPT 74363
|
| Hospital Charge Code |
909001856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.60 |
| Max. Negotiated Rate |
$1,987.20 |
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,766.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$883.20
|
| Rate for Payer: Galaxy Health WC |
$1,876.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,987.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,472.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$841.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,435.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,876.80
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
900910504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$44.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.39
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Media |
$5.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$5.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC BILIRUBIN ICTOTEST
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.09
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Caremore Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Media |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: InnovAge PACE Commercial |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$3.69
|
| Rate for Payer: Riverside University Health System MISP |
$3.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$44.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.39
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Media |
$5.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$5.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$44.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.45
|
| Rate for Payer: Blue Distinction Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$11.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.23
|
| Rate for Payer: Caremore Medicare Advantage |
$5.02
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Media |
$5.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.02
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Medicare |
$5.32
|
| Rate for Payer: Riverside University Health System MISP |
$5.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
IP
|
$21,061.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,212.20 |
| Max. Negotiated Rate |
$18,954.90 |
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Central Health Plan Commercial |
$16,848.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,424.40
|
| Rate for Payer: Galaxy Health WC |
$17,901.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12,636.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,954.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,024.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,212.20
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
| Rate for Payer: Networks By Design Commercial |
$13,689.65
|
| Rate for Payer: Prime Health Services Commercial |
$17,901.85
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
OP
|
$21,061.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,209.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,636.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$7,209.21
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Central Health Plan Commercial |
$16,848.80
|
| Rate for Payer: Cigna of CA PPO |
$15,585.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$17,901.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12,636.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,954.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15,795.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,823.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,895.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: InnovAge PACE Commercial |
$10,813.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,018.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,212.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,660.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
| Rate for Payer: Networks By Design Commercial |
$13,689.65
|
| Rate for Payer: Prime Health Services Commercial |
$17,901.85
|
| Rate for Payer: Prime Health Services Medicare |
$7,641.76
|
| Rate for Payer: Riverside University Health System MISP |
$7,930.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,636.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
IP
|
$21,061.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,212.20 |
| Max. Negotiated Rate |
$18,954.90 |
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Central Health Plan Commercial |
$16,848.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,424.40
|
| Rate for Payer: Galaxy Health WC |
$17,901.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12,636.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,954.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,024.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,212.20
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
| Rate for Payer: Networks By Design Commercial |
$13,689.65
|
| Rate for Payer: Prime Health Services Commercial |
$17,901.85
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
OP
|
$21,061.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,383.18 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,209.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,636.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$7,209.21
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Cash Price |
$9,477.45
|
| Rate for Payer: Central Health Plan Commercial |
$16,848.80
|
| Rate for Payer: Cigna of CA PPO |
$15,585.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$17,901.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12,636.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,954.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15,795.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,823.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,895.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: InnovAge PACE Commercial |
$10,813.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,047.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,684.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,212.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,660.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$15,795.75
|
| Rate for Payer: Networks By Design Commercial |
$13,689.65
|
| Rate for Payer: Prime Health Services Commercial |
$17,901.85
|
| Rate for Payer: Prime Health Services Medicare |
$7,641.76
|
| Rate for Payer: Riverside University Health System MISP |
$7,930.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,636.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
