|
HC LEAD REPAIR DUAL A & V
|
Facility
|
OP
|
$13,238.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$560.94 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,942.80
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$5,957.10
|
| Rate for Payer: Cash Price |
$5,957.10
|
| Rate for Payer: Cigna of CA PPO |
$9,796.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Media |
$4,906.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$11,252.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,942.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,928.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,046.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$8,046.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$10,590.40
|
| Rate for Payer: Networks By Design Commercial |
$8,604.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,252.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,942.80
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
IP
|
$13,238.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,177.12 |
| Max. Negotiated Rate |
$11,252.30 |
| Rate for Payer: Cash Price |
$5,957.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,295.20
|
| Rate for Payer: Galaxy Health WC |
$11,252.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,942.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,043.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,177.12
|
| Rate for Payer: Multiplan Commercial |
$10,590.40
|
| Rate for Payer: Networks By Design Commercial |
$8,604.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,252.30
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
OP
|
$13,238.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,942.80
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$5,957.10
|
| Rate for Payer: Cash Price |
$5,957.10
|
| Rate for Payer: Cigna of CA PPO |
$9,796.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Media |
$4,906.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$11,252.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,942.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,928.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,046.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$8,046.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$10,590.40
|
| Rate for Payer: Networks By Design Commercial |
$8,604.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,252.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,942.80
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
IP
|
$13,238.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,177.12 |
| Max. Negotiated Rate |
$11,252.30 |
| Rate for Payer: Cash Price |
$5,957.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,295.20
|
| Rate for Payer: Galaxy Health WC |
$11,252.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,942.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,043.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,177.12
|
| Rate for Payer: Multiplan Commercial |
$10,590.40
|
| Rate for Payer: Networks By Design Commercial |
$8,604.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,252.30
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
OP
|
$5,225.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.34 |
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$2,351.25
|
| Rate for Payer: Cash Price |
$2,351.25
|
| Rate for Payer: Cigna of CA PPO |
$3,866.50
|
| 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 |
$4,441.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,918.75
|
| 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 |
$3,485.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.00
|
| 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 |
$4,180.00
|
| Rate for Payer: Networks By Design Commercial |
$3,396.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,441.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,135.00
|
| 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 LEAD REPOSITION A OR V
|
Facility
|
IP
|
$5,225.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$4,441.25 |
| Rate for Payer: Cash Price |
$2,351.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,090.00
|
| Rate for Payer: Galaxy Health WC |
$4,441.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,990.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.00
|
| Rate for Payer: Multiplan Commercial |
$4,180.00
|
| Rate for Payer: Networks By Design Commercial |
$3,396.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,441.25
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,320.00 |
| Max. Negotiated Rate |
$4,675.00 |
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.00
|
| Rate for Payer: Galaxy Health WC |
$4,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,668.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.00
|
| Rate for Payer: Multiplan Commercial |
$4,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,675.00
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.76 |
| 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 |
$3,300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna of CA PPO |
$4,070.00
|
| 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 |
$4,675.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,300.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,125.00
|
| 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 |
$3,668.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.00
|
| 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 |
$4,400.00
|
| Rate for Payer: Networks By Design Commercial |
$3,575.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,675.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,300.00
|
| 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 LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$82,271.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,289.53 |
| Max. Negotiated Rate |
$69,930.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,933.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,249.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45,249.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$49,362.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,851.81
|
| Rate for Payer: Blue Shield of California EPN |
$5,110.40
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cigna of CA PPO |
$60,880.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Dignity Health Media |
$69,930.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69,930.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,908.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$32,908.40
|
| Rate for Payer: Galaxy Health WC |
$69,930.35
|
| Rate for Payer: Global Benefits Group Commercial |
$49,362.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61,703.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54,874.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,745.04
|
| Rate for Payer: Multiplan Commercial |
$65,816.80
|
| Rate for Payer: Networks By Design Commercial |
$53,476.15
|
| Rate for Payer: Prime Health Services Commercial |
$69,930.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49,362.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Senior |
$69,930.35
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
IP
|
$82,271.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,745.04 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,908.40
|
| Rate for Payer: Galaxy Health WC |
$69,930.35
|
| Rate for Payer: Global Benefits Group Commercial |
$49,362.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54,874.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,345.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,745.04
|
| Rate for Payer: Multiplan Commercial |
$65,816.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$69,930.35
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$12,490.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$313.77 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,036.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,616.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,869.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,869.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,494.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cigna of CA PPO |
$9,242.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,616.50
|
| Rate for Payer: Dignity Health Media |
$10,616.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,616.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,996.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,996.00
|
| Rate for Payer: Galaxy Health WC |
$10,616.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,494.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,367.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,997.60
|
| Rate for Payer: Multiplan Commercial |
$9,992.00
|
| Rate for Payer: Networks By Design Commercial |
$8,118.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,616.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,494.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,494.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,616.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,616.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,616.50
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$12,490.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,997.60 |
| Max. Negotiated Rate |
$10,616.50 |
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,996.00
|
| Rate for Payer: Galaxy Health WC |
$10,616.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,494.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,758.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,997.60
|
| Rate for Payer: Multiplan Commercial |
$9,992.00
|
| Rate for Payer: Networks By Design Commercial |
$8,118.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,616.50
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,449.43 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,303.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,810.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cigna of CA PPO |
$8,399.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$9,648.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,810.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,513.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,571.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,724.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$9,080.80
|
| Rate for Payer: Networks By Design Commercial |
$7,378.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,648.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,810.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,724.24 |
| Max. Negotiated Rate |
$9,648.35 |
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,540.40
|
| Rate for Payer: Galaxy Health WC |
$9,648.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,810.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,571.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,324.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,724.24
|
| Rate for Payer: Multiplan Commercial |
$9,080.80
|
| Rate for Payer: Networks By Design Commercial |
$7,378.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,648.35
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.92 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$484.80
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| 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 |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.92 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.42 |
| Max. Negotiated Rate |
$1,761.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$762.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.42
|
| Rate for Payer: Blue Distinction Transplant |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$253.23
|
| Rate for Payer: Blue Shield of California EPN |
$200.70
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$313.60
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC LEUK ALK PHOS
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$78.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.44
|
| Rate for Payer: Blue Distinction Transplant |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.42
|
| Rate for Payer: Blue Shield of California EPN |
$22.53
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.90
|
| Rate for Payer: Dignity Health Media |
$8.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.60
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.60
|
|
|
HC LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$319.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$319.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.87
|
| Rate for Payer: Blue Distinction Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$96.90
|
| Rate for Payer: Blue Shield of California EPN |
$76.80
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Media |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.94
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
OP
|
$1,451.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$268.11 |
| Max. Negotiated Rate |
$1,330.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,330.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$864.51
|
| Rate for Payer: Blue Distinction Transplant |
$870.60
|
| Rate for Payer: Blue Shield of California Commercial |
$857.54
|
| Rate for Payer: Blue Shield of California EPN |
$680.52
|
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: Cigna of CA HMO |
$928.64
|
| Rate for Payer: Cigna of CA PPO |
$1,073.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,233.35
|
| Rate for Payer: Global Benefits Group Commercial |
$870.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,088.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,160.80
|
| Rate for Payer: Networks By Design Commercial |
$943.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,233.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
IP
|
$1,451.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$348.24 |
| Max. Negotiated Rate |
$1,233.35 |
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.40
|
| Rate for Payer: Galaxy Health WC |
$1,233.35
|
| Rate for Payer: Global Benefits Group Commercial |
$870.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.24
|
| Rate for Payer: Multiplan Commercial |
$1,160.80
|
| Rate for Payer: Networks By Design Commercial |
$943.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,233.35
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
|
