|
HC IPV SUB
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800321
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$514.25 |
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
900910437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.41
|
| Rate for Payer: Blue Distinction Transplant |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.41
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Media |
$8.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.74
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Vantage Medical Group Senior |
$8.74
|
|
|
HC IRON TOTAL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$59.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.09
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Media |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$125.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.14
|
| Rate for Payer: Blue Distinction Transplant |
$179.40
|
| Rate for Payer: Blue Shield of California Commercial |
$220.36
|
| Rate for Payer: Blue Shield of California EPN |
$174.62
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cigna of CA HMO |
$191.36
|
| Rate for Payer: Cigna of CA PPO |
$221.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$224.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$179.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$179.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$254.15 |
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.96 |
| 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 |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$572.40
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna of CA PPO |
$705.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| 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 |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$763.20
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$572.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$477.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.96 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.96
|
| Rate for Payer: Multiplan Commercial |
$763.20
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.69 |
| 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 |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,367.40
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cigna of CA PPO |
$1,686.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,709.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| 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 |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,367.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,139.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,139.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,139.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,139.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$546.96 |
| Max. Negotiated Rate |
$1,937.15 |
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.60
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.96
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$177.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.30
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$298.48
|
| Rate for Payer: Blue Shield of California EPN |
$236.52
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$177.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.30
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$298.48
|
| Rate for Payer: Blue Shield of California EPN |
$236.52
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$177.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.30
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$298.48
|
| Rate for Payer: Blue Shield of California EPN |
$236.52
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$177.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.30
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$298.48
|
| Rate for Payer: Blue Shield of California EPN |
$236.52
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.00
|
| Rate for Payer: Galaxy Health WC |
$323.00
|
| Rate for Payer: Global Benefits Group Commercial |
$228.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$304.00
|
| Rate for Payer: Networks By Design Commercial |
$247.00
|
| Rate for Payer: Prime Health Services Commercial |
$323.00
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.40
|
| Rate for Payer: Blue Distinction Transplant |
$228.00
|
| Rate for Payer: Blue Shield of California Commercial |
$280.06
|
| Rate for Payer: Blue Shield of California EPN |
$221.92
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna of CA HMO |
$243.20
|
| Rate for Payer: Cigna of CA PPO |
$281.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Media |
$12.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$323.00
|
| Rate for Payer: Global Benefits Group Commercial |
$228.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$285.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.86
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$19.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$304.00
|
| Rate for Payer: Networks By Design Commercial |
$247.00
|
| Rate for Payer: Prime Health Services Commercial |
$323.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.42 |
| 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 |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$603.60
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$754.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| 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 |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$503.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$503.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.44 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.42 |
| 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 |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$603.60
|
| Rate for Payer: Blue Shield of California Commercial |
$741.42
|
| Rate for Payer: Blue Shield of California EPN |
$587.50
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cigna of CA HMO |
$643.84
|
| Rate for Payer: Cigna of CA PPO |
$744.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$754.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$603.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$503.00
|
| Rate for Payer: United Healthcare All Other HMO |
$503.00
|
| Rate for Payer: United Healthcare HMO Rider |
$503.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$503.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.44 |
| Max. Negotiated Rate |
$855.10 |
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.40
|
| Rate for Payer: Galaxy Health WC |
$855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$603.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.44
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Networks By Design Commercial |
$653.90
|
| Rate for Payer: Prime Health Services Commercial |
$855.10
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.59 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,244.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: Cigna of CA PPO |
$10,168.34
|
| 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 |
$11,679.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,305.75
|
| 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 |
$9,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.84
|
| 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 |
$10,992.80
|
| Rate for Payer: Networks By Design Commercial |
$8,931.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,244.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,741.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,297.84 |
| Max. Negotiated Rate |
$11,679.85 |
| Rate for Payer: Cash Price |
$6,183.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.40
|
| Rate for Payer: Galaxy Health WC |
$11,679.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,244.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,235.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,297.84
|
| Rate for Payer: Multiplan Commercial |
$10,992.80
|
| Rate for Payer: Networks By Design Commercial |
$8,931.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,679.85
|
|
