|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
IP
|
$5,073.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,217.52 |
| Max. Negotiated Rate |
$4,312.05 |
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,029.20
|
| Rate for Payer: Galaxy Health WC |
$4,312.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,043.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,383.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,932.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,217.52
|
| Rate for Payer: Multiplan Commercial |
$4,058.40
|
| Rate for Payer: Networks By Design Commercial |
$3,297.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.05
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,053.84 |
| Max. Negotiated Rate |
$3,732.35 |
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,756.40
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.84
|
| Rate for Payer: Multiplan Commercial |
$3,512.80
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,053.84 |
| Max. Negotiated Rate |
$3,732.35 |
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,756.40
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,672.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.84
|
| Rate for Payer: Multiplan Commercial |
$3,512.80
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,053.84 |
| 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 |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,634.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cigna of CA PPO |
$3,249.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,293.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,512.80
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,634.60
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$4,391.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,634.60
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cash Price |
$1,975.95
|
| Rate for Payer: Cigna of CA PPO |
$3,249.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,732.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,634.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,293.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| 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 |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,928.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,053.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,512.80
|
| Rate for Payer: Networks By Design Commercial |
$2,854.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,732.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,634.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,854.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,404.96 |
| Max. Negotiated Rate |
$4,975.90 |
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.60
|
| Rate for Payer: Galaxy Health WC |
$4,975.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,512.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,230.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,404.96
|
| Rate for Payer: Multiplan Commercial |
$4,683.20
|
| Rate for Payer: Networks By Design Commercial |
$3,805.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.90
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$620.40 |
| 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 |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,551.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cigna of CA PPO |
$1,912.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,197.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,551.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,938.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,724.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Networks By Design Commercial |
$1,680.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,197.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,551.00
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$620.40 |
| 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 |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,551.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cigna of CA PPO |
$1,912.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,197.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,551.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,938.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,724.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Networks By Design Commercial |
$1,680.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,197.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,551.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$620.40 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,551.00
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cigna of CA PPO |
$1,912.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,197.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,551.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,938.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| 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 |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,724.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Networks By Design Commercial |
$1,680.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,197.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,551.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,292.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,292.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,292.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,292.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,854.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,404.96 |
| Max. Negotiated Rate |
$4,975.90 |
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.60
|
| Rate for Payer: Galaxy Health WC |
$4,975.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,512.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,230.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,404.96
|
| Rate for Payer: Multiplan Commercial |
$4,683.20
|
| Rate for Payer: Networks By Design Commercial |
$3,805.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.90
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$5,854.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,404.96 |
| Max. Negotiated Rate |
$4,975.90 |
| Rate for Payer: Cash Price |
$2,634.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.60
|
| Rate for Payer: Galaxy Health WC |
$4,975.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,512.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,230.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,404.96
|
| Rate for Payer: Multiplan Commercial |
$4,683.20
|
| Rate for Payer: Networks By Design Commercial |
$3,805.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.90
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
OP
|
$12,373.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.95 |
| 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 |
$7,423.80
|
| 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 |
$5,567.85
|
| Rate for Payer: Cash Price |
$5,567.85
|
| Rate for Payer: Cigna of CA PPO |
$9,156.02
|
| 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 |
$10,517.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,423.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,279.75
|
| 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 |
$8,252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,969.52
|
| 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 |
$9,898.40
|
| Rate for Payer: Networks By Design Commercial |
$8,042.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,517.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,423.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 REPLACE PORT THRU SAME ACCESS
|
Facility
|
IP
|
$12,373.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,969.52 |
| Max. Negotiated Rate |
$10,517.05 |
| Rate for Payer: Cash Price |
$5,567.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,949.20
|
| Rate for Payer: Galaxy Health WC |
$10,517.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,423.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,714.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,969.52
|
| Rate for Payer: Multiplan Commercial |
$9,898.40
|
| Rate for Payer: Networks By Design Commercial |
$8,042.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,517.05
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$13,197.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,167.28 |
| Max. Negotiated Rate |
$11,217.45 |
| Rate for Payer: Cash Price |
$5,938.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,278.80
|
| Rate for Payer: Galaxy Health WC |
$11,217.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,918.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,802.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,028.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,167.28
|
| Rate for Payer: Multiplan Commercial |
$10,557.60
|
| Rate for Payer: Networks By Design Commercial |
$8,578.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,217.45
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$13,197.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,649.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,918.20
|
| Rate for Payer: Cash Price |
$5,938.65
|
| Rate for Payer: Cash Price |
$5,938.65
|
| Rate for Payer: Cash Price |
$5,938.65
|
| Rate for Payer: Cigna of CA PPO |
$9,765.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$11,217.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,918.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,897.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,649.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$13,649.79
|
| 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 |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,802.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$10,557.60
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: Networks By Design Commercial |
$8,578.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,217.45
|
| Rate for Payer: Prime Health Services WC |
$11,262.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,918.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,598.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,598.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,598.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,598.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$13,377.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,210.48 |
| Max. Negotiated Rate |
$11,370.45 |
| Rate for Payer: Cash Price |
$6,019.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,350.80
|
| Rate for Payer: Galaxy Health WC |
$11,370.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,026.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,922.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,096.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.48
|
| Rate for Payer: Multiplan Commercial |
$10,701.60
|
| Rate for Payer: Networks By Design Commercial |
$8,695.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,370.45
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$13,377.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$627.53 |
| 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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,026.20
|
| 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 |
$6,019.65
|
| Rate for Payer: Cash Price |
$6,019.65
|
| Rate for Payer: Cigna of CA PPO |
$9,898.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$11,370.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,026.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,032.75
|
| 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 |
$8,922.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.48
|
| 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 |
$10,701.60
|
| Rate for Payer: Networks By Design Commercial |
$8,695.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,370.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,026.20
|
| 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 REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,406.24 |
| Max. Negotiated Rate |
$8,522.10 |
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,010.40
|
| Rate for Payer: Galaxy Health WC |
$8,522.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,015.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,687.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,819.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,406.24
|
| Rate for Payer: Multiplan Commercial |
$8,020.80
|
| Rate for Payer: Networks By Design Commercial |
$6,516.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,522.10
|
|
|
HC REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
OP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906811582
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$627.53 |
| 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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,015.60
|
| 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 |
$4,511.70
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Cigna of CA PPO |
$7,419.24
|
| 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 |
$8,522.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,015.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,519.50
|
| 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 |
$6,687.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,406.24
|
| 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 |
$8,020.80
|
| Rate for Payer: Networks By Design Commercial |
$6,516.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,522.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,015.60
|
| 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 REPLANTATION DIGIT, COMPLETE
|
Facility
|
IP
|
$6,627.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,590.48 |
| Max. Negotiated Rate |
$5,632.95 |
| Rate for Payer: Cash Price |
$2,982.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,650.80
|
| Rate for Payer: Galaxy Health WC |
$5,632.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,976.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,524.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,590.48
|
| Rate for Payer: Multiplan Commercial |
$5,301.60
|
| Rate for Payer: Networks By Design Commercial |
$4,307.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,632.95
|
|
|
HC REPLANTATION DIGIT, COMPLETE
|
Facility
|
OP
|
$6,627.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$8,628.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,976.20
|
| Rate for Payer: Cash Price |
$2,982.15
|
| Rate for Payer: Cash Price |
$2,982.15
|
| Rate for Payer: Cash Price |
$2,982.15
|
| Rate for Payer: Cigna of CA PPO |
$4,903.98
|
| 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 |
$5,632.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,976.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,970.25
|
| 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 |
$4,420.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,626.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,590.48
|
| 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 |
$5,301.60
|
| Rate for Payer: Networks By Design Commercial |
$4,307.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,632.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,976.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,313.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,313.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,313.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,313.50
|
| 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 REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$10,655.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
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 REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$10,655.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.76 |
| 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 |
$4,984.00
|
| 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 |
$279.76
|
| 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 REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,296.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.55 |
| 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 |
$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 |
$2,577.60
|
| 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 |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cigna of CA PPO |
$3,179.04
|
| 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 |
$3,651.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,577.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,222.00
|
| 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 |
$2,865.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.04
|
| 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 |
$3,436.80
|
| Rate for Payer: Networks By Design Commercial |
$2,792.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,651.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,577.60
|
| 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 |
$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 REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,296.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.55 |
| 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 |
$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 |
$2,577.60
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cigna of CA PPO |
$3,179.04
|
| 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 |
$3,651.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,577.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,222.00
|
| 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 |
$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 |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,865.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.04
|
| 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 |
$3,436.80
|
| Rate for Payer: Networks By Design Commercial |
$2,792.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,651.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,577.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,148.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,148.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,148.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,148.00
|
| 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
|
|
