|
HC RED CELL SURVIVAL
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$425.04 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$787.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,055.16
|
| Rate for Payer: Blue Distinction Transplant |
$1,062.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,046.66
|
| Rate for Payer: Blue Shield of California EPN |
$830.60
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,328.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| 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 |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,199.40
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cigna of CA PPO |
$1,479.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,499.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,872.77
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,872.77
|
| 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 |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,199.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$999.50
|
| Rate for Payer: United Healthcare All Other HMO |
$999.50
|
| Rate for Payer: United Healthcare HMO Rider |
$999.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$479.76 |
| Max. Negotiated Rate |
$1,699.15 |
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.60
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.76
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$19.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.72
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$5.12
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Media |
$2.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$3.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.94 |
| 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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,197.00
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cigna of CA PPO |
$1,476.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,496.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| 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 |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,330.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$386.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$1,596.00
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,197.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$997.50
|
| Rate for Payer: United Healthcare All Other HMO |
$997.50
|
| Rate for Payer: United Healthcare HMO Rider |
$997.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.00
|
| Rate for Payer: Galaxy Health WC |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,330.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$1,596.00
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$443.04 |
| Max. Negotiated Rate |
$1,569.10 |
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Networks By Design Commercial |
$1,199.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.73 |
| Max. Negotiated Rate |
$1,569.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$550.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$575.36
|
| Rate for Payer: Blue Distinction Transplant |
$1,107.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,090.99
|
| Rate for Payer: Blue Shield of California EPN |
$865.77
|
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Cash Price |
$830.70
|
| Rate for Payer: Cigna of CA HMO |
$1,181.44
|
| Rate for Payer: Cigna of CA PPO |
$1,366.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,569.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,107.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,384.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,231.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Networks By Design Commercial |
$1,199.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,569.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,107.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,107.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$516.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$126.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$773.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$546.00
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cigna of CA HMO |
$582.40
|
| Rate for Payer: Cigna of CA PPO |
$673.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$682.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$164.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Networks By Design Commercial |
$591.50
|
| Rate for Payer: Prime Health Services Commercial |
$773.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$773.50 |
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$364.00
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Networks By Design Commercial |
$591.50
|
| Rate for Payer: Prime Health Services Commercial |
$773.50
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$773.50 |
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$364.00
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Networks By Design Commercial |
$591.50
|
| Rate for Payer: Prime Health Services Commercial |
$773.50
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$53.33 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$773.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$546.00
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cigna of CA HMO |
$582.40
|
| Rate for Payer: Cigna of CA PPO |
$673.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$773.50
|
| Rate for Payer: Global Benefits Group Commercial |
$546.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$682.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$164.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Networks By Design Commercial |
$591.50
|
| Rate for Payer: Prime Health Services Commercial |
$773.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$929.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$612.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna of CA HMO |
$652.80
|
| Rate for Payer: Cigna of CA PPO |
$754.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$765.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$173.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,856.00 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,760.00
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,937.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,533.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,140.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cigna of CA PPO |
$8,806.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,925.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| 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 |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,937.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,140.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$116.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.69
|
| Rate for Payer: Blue Distinction Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$124.55
|
| Rate for Payer: Blue Shield of California EPN |
$98.70
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$135.20
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$135.20
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
|
HC REM AUTON ALG INSLN DATA COLL
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
|
|
HC REM AUTON ALG INSLN DATA COLL
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$297.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.37
|
| Rate for Payer: Blue Distinction Transplant |
$61.80
|
| Rate for Payer: Blue Shield of California Commercial |
$75.91
|
| Rate for Payer: Blue Shield of California EPN |
$60.15
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Media |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$77.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$77.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,730.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,296.91
|
| Rate for Payer: Blue Distinction Transplant |
$4,327.20
|
| 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 |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cigna of CA HMO |
$4,615.68
|
| Rate for Payer: Cigna of CA PPO |
$5,336.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$6,130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,327.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,409.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,810.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,730.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$5,769.60
|
| Rate for Payer: Networks By Design Commercial |
$4,687.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,130.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,327.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,327.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
IP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,730.88 |
| Max. Negotiated Rate |
$6,130.20 |
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,884.80
|
| Rate for Payer: Galaxy Health WC |
$6,130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,327.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,810.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,747.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,730.88
|
| Rate for Payer: Multiplan Commercial |
$5,769.60
|
| Rate for Payer: Networks By Design Commercial |
$4,687.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,130.20
|
|
