|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
901200030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$134.16 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
|
HC PHLEBOTOMY THERAPEUTIC
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
901200030
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$134.16 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$589.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$411.98
|
| Rate for Payer: Blue Shield of California EPN |
$326.46
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cigna of CA HMO |
$357.76
|
| Rate for Payer: Cigna of CA PPO |
$413.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$419.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$335.40
|
| 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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$145.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.88
|
| Rate for Payer: Blue Distinction Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$40.70
|
| Rate for Payer: Blue Shield of California EPN |
$32.26
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.78
|
| Rate for Payer: Dignity Health Media |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.52
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.09
|
| Rate for Payer: Heritage Provider Network Transplant |
$27.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.38
|
| Rate for Payer: United Healthcare All Other HMO |
$13.38
|
| Rate for Payer: United Healthcare HMO Rider |
$13.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$47.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.17
|
| 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 |
$8.67
|
| Rate for Payer: Dignity Health Media |
$5.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.78
|
| 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 |
$9.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| 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 |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHORUS
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$43.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.18
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Media |
$4.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.74
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.96 |
| 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 |
$1,089.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$726.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$947.40
|
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: Cigna of CA PPO |
$1,168.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Dignity Health Media |
$726.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$726.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$726.26
|
| Rate for Payer: Galaxy Health WC |
$1,342.15
|
| Rate for Payer: Global Benefits Group Commercial |
$947.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,184.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,191.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,191.07
|
| 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 |
$726.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$915.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.19
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: Networks By Design Commercial |
$1,026.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,342.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$947.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$789.50
|
| Rate for Payer: United Healthcare All Other HMO |
$789.50
|
| Rate for Payer: United Healthcare HMO Rider |
$789.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$789.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Vantage Medical Group Senior |
$726.26
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.96 |
| Max. Negotiated Rate |
$1,342.15 |
| Rate for Payer: Cash Price |
$710.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.60
|
| Rate for Payer: Galaxy Health WC |
$1,342.15
|
| Rate for Payer: Global Benefits Group Commercial |
$947.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.96
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: Networks By Design Commercial |
$1,026.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,342.15
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,934.64 |
| Max. Negotiated Rate |
$6,851.85 |
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$8,061.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,934.64 |
| Max. Negotiated Rate |
$6,851.85 |
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.40
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,934.64 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,782.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,836.60
|
| 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 |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cigna of CA PPO |
$5,965.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Dignity Health Media |
$5,782.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,360.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,805.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,782.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,782.14
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,045.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,482.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$9,482.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9,367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,782.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,748.07
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| 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 |
$8,673.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,782.14
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$8,061.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,934.64 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,782.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,836.60
|
| 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 |
$3,627.45
|
| Rate for Payer: Cash Price |
$3,627.45
|
| Rate for Payer: Cigna of CA PPO |
$5,965.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,673.21
|
| Rate for Payer: Dignity Health Media |
$5,782.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,360.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,805.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5,782.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,782.14
|
| Rate for Payer: Galaxy Health WC |
$6,851.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,836.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,045.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,482.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$9,482.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9,367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,782.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,934.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,748.07
|
| Rate for Payer: Multiplan Commercial |
$6,448.80
|
| Rate for Payer: Networks By Design Commercial |
$5,239.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,851.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,836.60
|
| 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 |
$8,673.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,360.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,782.14
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
IP
|
$89,809.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,554.16 |
| Max. Negotiated Rate |
$76,337.65 |
| Rate for Payer: Cash Price |
$40,414.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,923.60
|
| Rate for Payer: Galaxy Health WC |
$76,337.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53,885.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,902.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,217.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,554.16
|
| Rate for Payer: Multiplan Commercial |
$71,847.20
|
| Rate for Payer: Networks By Design Commercial |
$58,375.85
|
| Rate for Payer: Prime Health Services Commercial |
$76,337.65
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
OP
|
$89,809.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$103,995.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,905.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76,337.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49,394.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49,394.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,579.00
|
| Rate for Payer: Blue Distinction Transplant |
$53,885.40
|
| 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 |
$40,414.05
|
| Rate for Payer: Cash Price |
$40,414.05
|
| Rate for Payer: Cash Price |
$40,414.05
|
| Rate for Payer: Cigna of CA PPO |
$66,458.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76,337.65
|
| Rate for Payer: Dignity Health Media |
$76,337.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$76,337.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,923.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$35,923.60
|
| Rate for Payer: Galaxy Health WC |
$76,337.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53,885.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67,356.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,902.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,217.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,554.16
|
| Rate for Payer: Multiplan Commercial |
$71,847.20
|
| Rate for Payer: Networks By Design Commercial |
$58,375.85
|
| Rate for Payer: Prime Health Services Commercial |
$76,337.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53,885.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76,337.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76,337.65
|
| Rate for Payer: Vantage Medical Group Senior |
$76,337.65
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
IP
|
$19,083.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,579.92 |
| Max. Negotiated Rate |
$16,220.55 |
| Rate for Payer: Cash Price |
$8,587.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,633.20
|
| Rate for Payer: Galaxy Health WC |
$16,220.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,449.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,270.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,579.92
|
| Rate for Payer: Multiplan Commercial |
$15,266.40
|
| Rate for Payer: Networks By Design Commercial |
$12,403.95
|
| Rate for Payer: Prime Health Services Commercial |
$16,220.55
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
OP
|
$19,083.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,516.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,220.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,495.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,495.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$11,449.80
|
| 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 |
$8,587.35
|
| Rate for Payer: Cash Price |
$8,587.35
|
| Rate for Payer: Cash Price |
$8,587.35
|
| Rate for Payer: Cigna of CA PPO |
$14,121.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,220.55
|
| Rate for Payer: Dignity Health Media |
$16,220.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,220.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,633.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,633.20
|
| Rate for Payer: Galaxy Health WC |
$16,220.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,449.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14,312.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,270.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,579.92
|
| Rate for Payer: Multiplan Commercial |
$15,266.40
|
| Rate for Payer: Networks By Design Commercial |
$12,403.95
|
| Rate for Payer: Prime Health Services Commercial |
$16,220.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,449.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,220.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,220.55
|
| Rate for Payer: Vantage Medical Group Senior |
$16,220.55
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$89,809.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$76,337.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,905.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76,337.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49,394.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49,394.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,579.00
|
| Rate for Payer: Blue Distinction Transplant |
$53,885.40
|
| 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 |
$40,414.05
|
| Rate for Payer: Cash Price |
$40,414.05
|
| Rate for Payer: Cash Price |
$40,414.05
|
| Rate for Payer: Cigna of CA PPO |
$66,458.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76,337.65
|
| Rate for Payer: Dignity Health Media |
$76,337.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$76,337.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,923.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$35,923.60
|
| Rate for Payer: Galaxy Health WC |
$76,337.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53,885.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67,356.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,902.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,217.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,554.16
|
| Rate for Payer: Multiplan Commercial |
$71,847.20
|
| Rate for Payer: Networks By Design Commercial |
$58,375.85
|
| Rate for Payer: Prime Health Services Commercial |
$76,337.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53,885.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$57,775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$67,976.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,652.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49,976.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76,337.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76,337.65
|
| Rate for Payer: Vantage Medical Group Senior |
$76,337.65
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$89,809.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,554.16 |
| Max. Negotiated Rate |
$76,337.65 |
| Rate for Payer: Cash Price |
$40,414.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,923.60
|
| Rate for Payer: Galaxy Health WC |
$76,337.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53,885.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,902.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,217.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,554.16
|
| Rate for Payer: Multiplan Commercial |
$71,847.20
|
| Rate for Payer: Networks By Design Commercial |
$58,375.85
|
| Rate for Payer: Prime Health Services Commercial |
$76,337.65
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
OP
|
$59,461.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$50,541.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,000.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50,541.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,703.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32,703.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$35,676.60
|
| 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 |
$26,757.45
|
| Rate for Payer: Cash Price |
$26,757.45
|
| Rate for Payer: Cash Price |
$26,757.45
|
| Rate for Payer: Cigna of CA PPO |
$44,001.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50,541.85
|
| Rate for Payer: Dignity Health Media |
$50,541.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,541.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,784.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$23,784.40
|
| Rate for Payer: Galaxy Health WC |
$50,541.85
|
| Rate for Payer: Global Benefits Group Commercial |
$35,676.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44,595.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,660.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,654.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,270.64
|
| Rate for Payer: Multiplan Commercial |
$47,568.80
|
| Rate for Payer: Networks By Design Commercial |
$38,649.65
|
| Rate for Payer: Prime Health Services Commercial |
$50,541.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50,541.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,541.85
|
| Rate for Payer: Vantage Medical Group Senior |
$50,541.85
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
IP
|
$59,461.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,270.64 |
| Max. Negotiated Rate |
$50,541.85 |
| Rate for Payer: Cash Price |
$26,757.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,784.40
|
| Rate for Payer: Galaxy Health WC |
$50,541.85
|
| Rate for Payer: Global Benefits Group Commercial |
$35,676.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,660.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,654.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,270.64
|
| Rate for Payer: Multiplan Commercial |
$47,568.80
|
| Rate for Payer: Networks By Design Commercial |
$38,649.65
|
| Rate for Payer: Prime Health Services Commercial |
$50,541.85
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
IP
|
$9,711.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,330.64 |
| Max. Negotiated Rate |
$8,254.35 |
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: Galaxy Health WC |
$8,254.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,826.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,699.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,330.64
|
| Rate for Payer: Multiplan Commercial |
$7,768.80
|
| Rate for Payer: Networks By Design Commercial |
$6,312.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,254.35
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
OP
|
$9,711.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,330.64 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,369.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,254.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,341.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,341.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,826.60
|
| 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 |
$4,369.95
|
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: Cigna of CA PPO |
$7,186.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,254.35
|
| Rate for Payer: Dignity Health Media |
$8,254.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,254.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,884.40
|
| Rate for Payer: Galaxy Health WC |
$8,254.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,826.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,283.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,699.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,330.64
|
| Rate for Payer: Multiplan Commercial |
$7,768.80
|
| Rate for Payer: Networks By Design Commercial |
$6,312.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,254.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,826.60
|
| 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 |
$8,254.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,254.35
|
| Rate for Payer: Vantage Medical Group Senior |
$8,254.35
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
OP
|
$9,711.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,330.64 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,369.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,254.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,341.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,341.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,579.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,826.60
|
| 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 |
$4,369.95
|
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: Cigna of CA PPO |
$7,186.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,254.35
|
| Rate for Payer: Dignity Health Media |
$8,254.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,254.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,884.40
|
| Rate for Payer: Galaxy Health WC |
$8,254.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,826.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,283.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,699.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,330.64
|
| Rate for Payer: Multiplan Commercial |
$7,768.80
|
| Rate for Payer: Networks By Design Commercial |
$6,312.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,254.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,826.60
|
| 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 |
$8,254.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,254.35
|
| Rate for Payer: Vantage Medical Group Senior |
$8,254.35
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
IP
|
$9,711.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,330.64 |
| Max. Negotiated Rate |
$8,254.35 |
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: Galaxy Health WC |
$8,254.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,826.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,699.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,330.64
|
| Rate for Payer: Multiplan Commercial |
$7,768.80
|
| Rate for Payer: Networks By Design Commercial |
$6,312.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,254.35
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
IP
|
$9,711.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,330.64 |
| Max. Negotiated Rate |
$8,254.35 |
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: Galaxy Health WC |
$8,254.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,826.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,699.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,330.64
|
| Rate for Payer: Multiplan Commercial |
$7,768.80
|
| Rate for Payer: Networks By Design Commercial |
$6,312.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,254.35
|
|
|
HC PHRNC NRV STIM RPSTN TRNSVNS LEAD
|
Facility
|
OP
|
$9,711.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906810432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,330.64 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,369.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,254.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,341.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,341.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,826.60
|
| 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 |
$4,369.95
|
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: Cash Price |
$4,369.95
|
| Rate for Payer: Cigna of CA PPO |
$7,186.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,254.35
|
| Rate for Payer: Dignity Health Media |
$8,254.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,254.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,884.40
|
| Rate for Payer: Galaxy Health WC |
$8,254.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,826.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,283.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,699.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,330.64
|
| Rate for Payer: Multiplan Commercial |
$7,768.80
|
| Rate for Payer: Networks By Design Commercial |
$6,312.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,254.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,826.60
|
| 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 |
$8,254.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,254.35
|
| Rate for Payer: Vantage Medical Group Senior |
$8,254.35
|
|
