|
HC SHTH PERCUTANEOUS 6FR
|
Facility
|
OP
|
$232.40
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.13
|
| Rate for Payer: Cash Price |
$104.58
|
| Rate for Payer: Cash Price |
$104.58
|
| Rate for Payer: Cigna of CA HMO |
$148.74
|
| Rate for Payer: Cigna of CA PPO |
$171.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.96
|
| Rate for Payer: EPIC Health Plan Senior |
$92.96
|
| Rate for Payer: Galaxy Health WC |
$197.54
|
| Rate for Payer: Global Benefits Group Commercial |
$139.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.68
|
| Rate for Payer: Multiplan Commercial |
$185.92
|
| Rate for Payer: Networks By Design Commercial |
$151.06
|
| Rate for Payer: Prime Health Services Commercial |
$197.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.20
|
| Rate for Payer: United Healthcare All Other HMO |
$116.20
|
| Rate for Payer: United Healthcare HMO Rider |
$116.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.54
|
| Rate for Payer: Vantage Medical Group Senior |
$197.54
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
OP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Cigna of CA HMO |
$137.85
|
| Rate for Payer: Cigna of CA PPO |
$159.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$172.31
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.69
|
| Rate for Payer: United Healthcare All Other HMO |
$107.69
|
| Rate for Payer: United Healthcare HMO Rider |
$107.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.08
|
| Rate for Payer: Vantage Medical Group Senior |
$183.08
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
IP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.69
|
| Rate for Payer: Multiplan Commercial |
$172.31
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
|
IP
|
$348.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$296.31 |
| Rate for Payer: Adventist Health Commercial |
$69.72
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$244.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Senior |
$139.44
|
| Rate for Payer: Galaxy Health WC |
$296.31
|
| Rate for Payer: Global Benefits Group Commercial |
$209.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$221.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$205.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.66
|
| Rate for Payer: Multiplan Commercial |
$278.88
|
| Rate for Payer: Networks By Design Commercial |
$226.59
|
| Rate for Payer: Prime Health Services Commercial |
$296.31
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
|
OP
|
$348.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$296.31 |
| Rate for Payer: Adventist Health Commercial |
$69.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.70
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: Cigna of CA HMO |
$223.10
|
| Rate for Payer: Cigna of CA PPO |
$257.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$244.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Senior |
$139.44
|
| Rate for Payer: Galaxy Health WC |
$296.31
|
| Rate for Payer: Global Benefits Group Commercial |
$209.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$221.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$126.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$205.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.02
|
| Rate for Payer: Multiplan Commercial |
$278.88
|
| Rate for Payer: Networks By Design Commercial |
$226.59
|
| Rate for Payer: Prime Health Services Commercial |
$296.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.30
|
| Rate for Payer: United Healthcare All Other HMO |
$174.30
|
| Rate for Payer: United Healthcare HMO Rider |
$174.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.31
|
| Rate for Payer: Vantage Medical Group Senior |
$296.31
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Vantage Medical Group Senior |
$237.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.41
|
| Rate for Payer: Adventist Health Commercial |
$55.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.23
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cigna of CA HMO |
$178.75
|
| Rate for Payer: Cigna of CA PPO |
$206.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: EPIC Health Plan Senior |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.41
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$195.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.51
|
| Rate for Payer: Multiplan Commercial |
$223.44
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.65
|
| Rate for Payer: United Healthcare All Other HMO |
$139.65
|
| Rate for Payer: United Healthcare HMO Rider |
$139.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.41
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$237.41 |
| Rate for Payer: Adventist Health Commercial |
$55.86
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: EPIC Health Plan Senior |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.41
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.03
|
| Rate for Payer: Multiplan Commercial |
$223.44
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.41
|
|
|
HC SHUNT EVALUATION
|
Facility
|
IP
|
$2,411.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$482.20 |
| Max. Negotiated Rate |
$2,049.35 |
| Rate for Payer: Adventist Health Commercial |
$482.20
|
| Rate for Payer: Cash Price |
$1,084.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,687.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$964.40
|
| Rate for Payer: Galaxy Health WC |
$2,049.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,446.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,530.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,422.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.64
|
| Rate for Payer: Multiplan Commercial |
$1,928.80
|
| Rate for Payer: Networks By Design Commercial |
$1,567.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,049.35
|
|
|
HC SHUNT EVALUATION
|
Facility
|
OP
|
$2,411.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$250.92 |
| Max. Negotiated Rate |
$2,049.35 |
| Rate for Payer: Adventist Health Commercial |
$482.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,731.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,547.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,538.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,015.03
|
| Rate for Payer: Cash Price |
$1,084.95
|
| Rate for Payer: Cash Price |
$1,084.95
|
| Rate for Payer: Cigna of CA HMO |
$1,543.04
|
| Rate for Payer: Cigna of CA PPO |
$1,784.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,687.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$2,049.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,446.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,530.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,928.80
|
| Rate for Payer: Networks By Design Commercial |
$1,567.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,049.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,446.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,446.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC SHUNTOGRAM
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$364.40
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$578.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$537.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.64
|
| Rate for Payer: Multiplan Commercial |
$728.80
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
|
|
HC SHUNTOGRAM
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$535.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.88
|
| Rate for Payer: Blue Shield of California Commercial |
$383.53
|
| Rate for Payer: Blue Shield of California Commercial |
$581.22
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cigna of CA HMO |
$583.04
|
| Rate for Payer: Cigna of CA PPO |
$674.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$578.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$728.80
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC SHVG LSN TRNK ARM LEG LT 0.5CM
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
902809295
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$284.70
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
|
|
HC SHVG LSN TRNK ARM LEG LT 0.5CM
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
902809295
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$50.22 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$179.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$280.32
|
| Rate for Payer: Cigna of CA PPO |
$324.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$284.70
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIALOGRAM
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$417.35 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.40
|
| Rate for Payer: EPIC Health Plan Senior |
$196.40
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.84
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
|
|
HC SIALOGRAM
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$605.23 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$596.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.85
|
| Rate for Payer: Blue Shield of California Commercial |
$206.71
|
| Rate for Payer: Blue Shield of California Commercial |
$313.26
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cigna of CA HMO |
$314.24
|
| Rate for Payer: Cigna of CA PPO |
$363.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
IP
|
$2,962.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$592.40 |
| Max. Negotiated Rate |
$2,517.70 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,073.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.80
|
| Rate for Payer: Galaxy Health WC |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,880.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,747.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Multiplan Commercial |
$2,369.60
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
OP
|
$2,962.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cigna of CA HMO |
$1,895.68
|
| Rate for Payer: Cigna of CA PPO |
$2,191.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,073.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,880.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$2,369.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,777.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,481.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$328.95 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cigna of CA HMO |
$247.68
|
| Rate for Payer: Cigna of CA PPO |
$286.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$328.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$328.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$367.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$270.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$270.90
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$328.95
|
| Rate for Payer: Vantage Medical Group Senior |
$328.95
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
IP
|
$7,530.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,506.00 |
| Max. Negotiated Rate |
$6,400.50 |
| Rate for Payer: Adventist Health Commercial |
$1,506.00
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,271.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,012.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,012.00
|
| Rate for Payer: Galaxy Health WC |
$6,400.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,518.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,781.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,442.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,807.20
|
| Rate for Payer: Multiplan Commercial |
$6,024.00
|
| Rate for Payer: Networks By Design Commercial |
$4,894.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,400.50
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
OP
|
$7,530.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cigna of CA HMO |
$4,819.20
|
| Rate for Payer: Cigna of CA PPO |
$5,572.20
|
| Rate for Payer: Adventist Health Commercial |
$1,506.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,271.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$6,400.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,518.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,781.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,807.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$6,024.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$4,894.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,400.50
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,518.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,765.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
OP
|
$3,712.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$437.88 |
| Max. Negotiated Rate |
$7,196.06 |
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Adventist Health Commercial |
$742.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$749.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,155.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,041.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,784.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Cigna of CA HMO |
$2,375.68
|
| Rate for Payer: Cigna of CA PPO |
$2,746.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,155.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,155.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,155.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,484.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,484.80
|
| Rate for Payer: Galaxy Health WC |
$3,155.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$437.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,357.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$495.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,190.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,598.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,598.40
|
| Rate for Payer: Multiplan Commercial |
$2,969.60
|
| Rate for Payer: Networks By Design Commercial |
$2,412.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,155.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,227.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,155.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,155.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,155.20
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
IP
|
$3,712.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$742.40 |
| Max. Negotiated Rate |
$3,155.20 |
| Rate for Payer: Adventist Health Commercial |
$742.40
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,484.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,484.80
|
| Rate for Payer: Galaxy Health WC |
$3,155.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,357.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,190.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.88
|
| Rate for Payer: Multiplan Commercial |
$2,969.60
|
| Rate for Payer: Networks By Design Commercial |
$2,412.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,155.20
|
|
|
HC SICKLE CELL SCREEN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC SICKLE CELL SCREEN
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.12
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$27.20
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Blue Shield of California Commercial |
$41.12
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Senior |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$6.06
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
