|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$30.93
|
| Rate for Payer: Blue Shield of California Commercial |
$46.91
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
|
|
HC VACCINE INFLUENZA VACCINE GT 3 YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
910400052
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23.53
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.43
|
| Rate for Payer: Blue Shield of California Commercial |
$140.50
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$171.70 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.41
|
| Rate for Payer: Blue Shield of California Commercial |
$155.34
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$927.91 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$927.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.43
|
| Rate for Payer: Blue Shield of California Commercial |
$140.50
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$171.70 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.41
|
| Rate for Payer: Blue Shield of California Commercial |
$155.34
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.30 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$943.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.00
|
| 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 |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$644.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$943.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$943.20
|
| 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 |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$628.80
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$628.80
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$628.80
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$943.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other HMO |
$786.00
|
| Rate for Payer: United Healthcare HMO Rider |
$786.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC VAD DRSNG CHANGE KIT W/PVP
|
Facility
|
OP
|
$220.85
|
|
| Hospital Charge Code |
901698893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$187.72 |
| Rate for Payer: Adventist Health Commercial |
$44.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.72
|
| Rate for Payer: Cash Price |
$99.38
|
| Rate for Payer: Cigna of CA HMO |
$141.34
|
| Rate for Payer: Cigna of CA PPO |
$163.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: EPIC Health Plan Senior |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.59
|
| Rate for Payer: Multiplan Commercial |
$176.68
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.42
|
| Rate for Payer: United Healthcare All Other HMO |
$110.42
|
| Rate for Payer: United Healthcare HMO Rider |
$110.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.72
|
| Rate for Payer: Vantage Medical Group Senior |
$187.72
|
|
|
HC VAD DRSNG CHANGE KIT W/PVP
|
Facility
|
IP
|
$220.85
|
|
| Hospital Charge Code |
901698893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$187.72 |
| Rate for Payer: Adventist Health Commercial |
$44.17
|
| Rate for Payer: Cash Price |
$99.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: EPIC Health Plan Senior |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$176.68
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
IP
|
$4,672.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$934.40 |
| Max. Negotiated Rate |
$3,971.20 |
| Rate for Payer: Adventist Health Commercial |
$934.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,270.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,868.80
|
| Rate for Payer: Galaxy Health WC |
$3,971.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,803.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,966.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,756.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.28
|
| Rate for Payer: Multiplan Commercial |
$3,737.60
|
| Rate for Payer: Networks By Design Commercial |
$3,036.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,971.20
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
OP
|
$4,672.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$14,599.62 |
| Rate for Payer: Adventist Health Commercial |
$934.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14,599.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,971.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,569.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,504.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,927.00
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,990.08
|
| Rate for Payer: Cigna of CA PPO |
$3,457.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,971.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,971.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,971.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,270.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,868.80
|
| Rate for Payer: Galaxy Health WC |
$3,971.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,803.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,513.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,966.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,973.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,756.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,270.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,270.40
|
| Rate for Payer: Multiplan Commercial |
$3,737.60
|
| Rate for Payer: Networks By Design Commercial |
$3,036.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,971.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,803.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,803.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,971.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,971.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,971.20
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$11,927.00 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,927.00
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cigna of CA HMO |
$2,384.00
|
| Rate for Payer: Cigna of CA PPO |
$2,756.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,365.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,034.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,235.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,862.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,862.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,862.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$3,166.25 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,607.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,490.00
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,365.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,197.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
|
|
HC VAGINAL REPAIR
|
Facility
|
OP
|
$7,073.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
902400755
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$349.74 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,014.40
|
| Rate for Payer: Adventist Health Commercial |
$1,414.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Cigna of CA HMO |
$4,526.72
|
| Rate for Payer: Cigna of CA PPO |
$5,234.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,951.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,012.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,243.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,491.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$395.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,697.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$5,658.40
|
| Rate for Payer: Networks By Design Commercial |
$4,597.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,012.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,243.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,243.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC VAGINAL REPAIR
|
Facility
|
IP
|
$7,073.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
902400755
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,414.60 |
| Max. Negotiated Rate |
$6,012.05 |
| Rate for Payer: Adventist Health Commercial |
$1,414.60
|
| Rate for Payer: Cash Price |
$3,182.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,951.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,829.20
|
| Rate for Payer: Galaxy Health WC |
$6,012.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,243.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,491.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,173.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,697.52
|
| Rate for Payer: Multiplan Commercial |
$5,658.40
|
| Rate for Payer: Networks By Design Commercial |
$4,597.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,012.05
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$139.81 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.81
|
| Rate for Payer: Blue Shield of California Commercial |
$100.50
|
| Rate for Payer: Blue Shield of California Commercial |
$53.48
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Blue Shield of California Commercial |
$80.85
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
