|
HC PLCMT CENTRLY INSERT TUN CVP GT 5YR
|
Facility
|
OP
|
$12,581.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
909080010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.70 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$7,548.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$5,661.45
|
| Rate for Payer: Cash Price |
$5,661.45
|
| Rate for Payer: Cigna of CA PPO |
$9,309.94
|
| 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 |
$10,693.85
|
| Rate for Payer: Global Benefits Group Commercial |
$7,548.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,435.75
|
| 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 |
$8,391.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,019.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$10,064.80
|
| Rate for Payer: Networks By Design Commercial |
$8,177.65
|
| Rate for Payer: Prime Health Services Commercial |
$10,693.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,548.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP LT 5YR
|
Facility
|
OP
|
$11,539.00
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
909081359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.98 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,923.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$5,192.55
|
| Rate for Payer: Cash Price |
$5,192.55
|
| Rate for Payer: Cigna of CA PPO |
$8,538.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$9,808.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,923.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,654.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,696.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$9,231.20
|
| Rate for Payer: Networks By Design Commercial |
$7,500.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,808.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,923.40
|
| 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 |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP LT 5YR
|
Facility
|
IP
|
$11,539.00
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
909081359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,769.36 |
| Max. Negotiated Rate |
$9,808.15 |
| Rate for Payer: Cash Price |
$5,192.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,615.60
|
| Rate for Payer: Galaxy Health WC |
$9,808.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,923.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,696.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,396.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.36
|
| Rate for Payer: Multiplan Commercial |
$9,231.20
|
| Rate for Payer: Networks By Design Commercial |
$7,500.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,808.15
|
|
|
HC PLCMT PERIPH INSRT CV DEVC W/P
|
Facility
|
IP
|
$10,655.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
909080016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,557.20 |
| Max. Negotiated Rate |
$9,056.75 |
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,262.00
|
| Rate for Payer: Galaxy Health WC |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,059.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,557.20
|
| Rate for Payer: Multiplan Commercial |
$8,524.00
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
|
|
HC PLCMT PERIPH INSRT CV DEVC W/P
|
Facility
|
OP
|
$10,655.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
909080016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$577.03 |
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,393.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cigna of CA PPO |
$7,884.70
|
| 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 |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,991.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,557.20
|
| 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 |
$8,524.00
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,393.00
|
| 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 PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
OP
|
$10,655.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$643.00 |
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,393.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cigna of CA PPO |
$7,884.70
|
| 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 |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,991.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,557.20
|
| 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 |
$8,524.00
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,393.00
|
| 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 PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
IP
|
$10,655.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,557.20 |
| Max. Negotiated Rate |
$9,056.75 |
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,262.00
|
| Rate for Payer: Galaxy Health WC |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,059.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,557.20
|
| Rate for Payer: Multiplan Commercial |
$8,524.00
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
OP
|
$10,655.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,393.00
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: Cigna of CA PPO |
$7,884.70
|
| 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 |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,991.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,557.20
|
| 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 |
$8,524.00
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,327.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,327.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,327.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,327.50
|
| 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 PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
IP
|
$10,655.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,557.20 |
| Max. Negotiated Rate |
$9,056.75 |
| Rate for Payer: Cash Price |
$4,794.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,262.00
|
| Rate for Payer: Galaxy Health WC |
$9,056.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,393.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,106.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,059.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,557.20
|
| Rate for Payer: Multiplan Commercial |
$8,524.00
|
| Rate for Payer: Networks By Design Commercial |
$6,925.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,056.75
|
|
|
HC PLC TUN CNTRL VAD W/SUB PRT LT 5YR
|
Facility
|
IP
|
$14,809.00
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
909080011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,554.16 |
| Max. Negotiated Rate |
$12,587.65 |
| Rate for Payer: Cash Price |
$6,664.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,923.60
|
| Rate for Payer: Galaxy Health WC |
$12,587.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,885.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,877.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,642.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,554.16
|
| Rate for Payer: Multiplan Commercial |
$11,847.20
|
| Rate for Payer: Networks By Design Commercial |
$9,625.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,587.65
|
|
|
HC PLC TUN CNTRL VAD W/SUB PRT LT 5YR
|
Facility
|
OP
|
$14,809.00
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
909080011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$498.35 |
| 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 |
$8,885.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$6,664.05
|
| Rate for Payer: Cash Price |
$6,664.05
|
| Rate for Payer: Cigna of CA PPO |
$10,958.66
|
| 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 |
$12,587.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,885.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,106.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,877.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,554.16
|
| 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 |
$11,847.20
|
| Rate for Payer: Networks By Design Commercial |
$9,625.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,587.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,885.40
|
| 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 PLEURA BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$2,480.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
909000123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$2,108.00 |
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.00
|
| Rate for Payer: Galaxy Health WC |
$2,108.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,488.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,654.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$944.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$595.20
|
| Rate for Payer: Multiplan Commercial |
$1,984.00
|
| Rate for Payer: Networks By Design Commercial |
$1,612.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,108.00
|
|
|
HC PLEURA BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$2,480.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
909000123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,488.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cigna of CA PPO |
$1,835.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$2,108.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,488.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,860.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,654.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$595.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$1,984.00
|
| Rate for Payer: Networks By Design Commercial |
$1,612.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC PLEURAL DRAIN PERC CATH WO IMAGE
|
Facility
|
IP
|
$2,290.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
909032556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,946.50 |
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$916.00
|
| Rate for Payer: Galaxy Health WC |
$1,946.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,374.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,527.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Multiplan Commercial |
$1,832.00
|
| Rate for Payer: Networks By Design Commercial |
$1,488.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,946.50
|
|
|
HC PLEURAL DRAIN PERC CATH WO IMAGE
|
Facility
|
OP
|
$2,290.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
909032556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,374.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna of CA PPO |
$1,694.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$1,946.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,374.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,717.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,527.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$549.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,832.00
|
| Rate for Payer: Networks By Design Commercial |
$1,488.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,946.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,374.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC PLEURAL DRAIN PLCMNT NO TUNN
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
909020159
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,090.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: Cigna of CA PPO |
$3,811.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,862.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,281.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,241.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$4,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,090.00
|
| 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 |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PLEURAL DRAIN PLCMNT NO TUNN
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
909020159
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,236.00 |
| Max. Negotiated Rate |
$4,377.50 |
| Rate for Payer: Cash Price |
$2,317.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.00
|
| Rate for Payer: Galaxy Health WC |
$4,377.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,090.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,435.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,962.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,236.00
|
| Rate for Payer: Multiplan Commercial |
$4,120.00
|
| Rate for Payer: Networks By Design Commercial |
$3,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,377.50
|
|
|
HC PLEURODESIS
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
909000202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.38 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,482.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cigna of CA PPO |
$1,828.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,100.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,853.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,648.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$1,976.80
|
| Rate for Payer: Networks By Design Commercial |
$1,606.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,100.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,482.60
|
| 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 |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC PLEURODESIS
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
909000202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$2,100.35 |
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.40
|
| Rate for Payer: Galaxy Health WC |
$2,100.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,648.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$941.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.04
|
| Rate for Payer: Multiplan Commercial |
$1,976.80
|
| Rate for Payer: Networks By Design Commercial |
$1,606.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,100.35
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$225.00 |
| 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 |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| 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 |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| 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 |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| 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 |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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 POLYS MICRO EXAM
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900910045
|
|
Hospital Revenue Code
|
300
|
| 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 |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| 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 |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| 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 |
$11.34
|
| 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 |
$4.08
|
| 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 |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| 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 POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$183.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$192.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cigna of CA HMO |
$205.44
|
| Rate for Payer: Cigna of CA PPO |
$237.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.85
|
| Rate for Payer: Dignity Health Media |
$272.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$128.40
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$240.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.85
|
| Rate for Payer: Vantage Medical Group Senior |
$272.85
|
|
|
HC POOL EXERCISE EA ADDL 15 MIN PT
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400413
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.04 |
| Max. Negotiated Rate |
$272.85 |
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.40
|
| Rate for Payer: Galaxy Health WC |
$272.85
|
| Rate for Payer: Global Benefits Group Commercial |
$192.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.04
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Networks By Design Commercial |
$208.65
|
| Rate for Payer: Prime Health Services Commercial |
$272.85
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$183.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$288.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$307.20
|
| Rate for Payer: Cigna of CA PPO |
$355.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Media |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
HC POOL EXERCISE INIT 30 MIN PT
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900400412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
|
