|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
947200110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
948100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
948100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
947300110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
946000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
944000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
947200110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
940100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
946000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
940100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
|
OP
|
$5,390.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.28 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,234.00
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: Cigna of CA PPO |
$3,988.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$4,581.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,042.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,595.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$4,312.00
|
| Rate for Payer: Networks By Design Commercial |
$3,503.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,581.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,234.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,695.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,695.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,695.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,695.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
|
IP
|
$5,390.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,293.60 |
| Max. Negotiated Rate |
$4,581.50 |
| Rate for Payer: Blue Shield of California Commercial |
$3,837.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,759.68
|
| Rate for Payer: Cash Price |
$2,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,156.00
|
| Rate for Payer: Galaxy Health WC |
$4,581.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,595.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,053.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.60
|
| Rate for Payer: Multiplan Commercial |
$4,312.00
|
| Rate for Payer: Networks By Design Commercial |
$3,503.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,581.50
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
IP
|
$8,674.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,081.76 |
| Max. Negotiated Rate |
$7,372.90 |
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,469.60
|
| Rate for Payer: Galaxy Health WC |
$7,372.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,204.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,785.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.76
|
| Rate for Payer: Multiplan Commercial |
$6,939.20
|
| Rate for Payer: Networks By Design Commercial |
$5,638.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,372.90
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$8,674.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$7,372.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,204.40
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cigna of CA PPO |
$6,418.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,372.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,204.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,505.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,785.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,939.20
|
| Rate for Payer: Networks By Design Commercial |
$5,638.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,372.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,204.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,337.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,337.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$8,674.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$7,372.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$518.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,204.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,392.74
|
| Rate for Payer: Blue Shield of California EPN |
$5,065.62
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cigna of CA HMO |
$5,551.36
|
| Rate for Payer: Cigna of CA PPO |
$6,418.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,372.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,204.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,505.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,785.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,939.20
|
| Rate for Payer: Networks By Design Commercial |
$5,638.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,372.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,204.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,204.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
IP
|
$8,674.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,081.76 |
| Max. Negotiated Rate |
$7,372.90 |
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,469.60
|
| Rate for Payer: Galaxy Health WC |
$7,372.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,204.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,785.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.76
|
| Rate for Payer: Multiplan Commercial |
$6,939.20
|
| Rate for Payer: Networks By Design Commercial |
$5,638.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,372.90
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.12
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$437.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.17
|
| Rate for Payer: Blue Distinction Transplant |
$232.80
|
| Rate for Payer: Blue Shield of California Commercial |
$285.96
|
| Rate for Payer: Blue Shield of California EPN |
$226.59
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna of CA HMO |
$248.32
|
| Rate for Payer: Cigna of CA PPO |
$287.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$194.00
|
| Rate for Payer: United Healthcare All Other HMO |
$194.00
|
| Rate for Payer: United Healthcare HMO Rider |
$194.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$232.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna of CA HMO |
$248.32
|
| Rate for Payer: Cigna of CA PPO |
$287.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.12
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
IP
|
$644.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$547.40 |
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
OP
|
$644.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$547.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$422.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.70
|
| Rate for Payer: Blue Distinction Transplant |
$386.40
|
| Rate for Payer: Blue Shield of California Commercial |
$380.60
|
| Rate for Payer: Blue Shield of California EPN |
$302.04
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO |
$412.16
|
| Rate for Payer: Cigna of CA PPO |
$476.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Media |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$418.60
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$322.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$338.50 |
| Max. Negotiated Rate |
$7,822.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,563.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,289.13
|
| Rate for Payer: Blue Distinction Transplant |
$5,521.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,438.97
|
| Rate for Payer: Blue Shield of California EPN |
$4,316.21
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Cigna of CA HMO |
$5,889.92
|
| Rate for Payer: Cigna of CA PPO |
$6,810.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$7,822.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,521.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,902.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,138.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,208.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,362.40
|
| Rate for Payer: Networks By Design Commercial |
$5,981.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,822.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,521.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,521.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,208.72 |
| Max. Negotiated Rate |
$7,822.55 |
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,681.20
|
| Rate for Payer: Galaxy Health WC |
$7,822.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,521.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,138.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,208.72
|
| Rate for Payer: Multiplan Commercial |
$7,362.40
|
| Rate for Payer: Networks By Design Commercial |
$5,981.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,822.55
|
|
|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$378.24 |
| Max. Negotiated Rate |
$2,327.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,662.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,327.11
|
| Rate for Payer: Blue Distinction Transplant |
$945.60
|
| Rate for Payer: Blue Shield of California Commercial |
$931.42
|
| Rate for Payer: Blue Shield of California EPN |
$739.14
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna of CA HMO |
$1,008.64
|
| Rate for Payer: Cigna of CA PPO |
$1,166.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$1,339.60
|
| Rate for Payer: Global Benefits Group Commercial |
$945.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,182.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,051.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$1,260.80
|
| Rate for Payer: Networks By Design Commercial |
$1,024.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,339.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$945.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
