|
HC STREPTOCARD STREP C
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$42.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.69
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP D
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$42.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.69
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP F
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912487
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$42.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.69
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP G
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912488
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$42.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.69
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOZYME TEST
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86063
|
| Hospital Charge Code |
900910870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.76
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.66
|
| Rate for Payer: Dignity Health Media |
$5.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.73
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Other HMO |
$4.67
|
| Rate for Payer: United Healthcare HMO Rider |
$4.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
|
|
HC STR POST TX CD3 ENGRAFTMENT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$194.88 |
| Max. Negotiated Rate |
$690.20 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.80
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
|
|
HC STR POST TX CD3 ENGRAFTMENT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902026
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$194.88 |
| Max. Negotiated Rate |
$2,348.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,348.98
|
| Rate for Payer: Blue Distinction Transplant |
$487.20
|
| Rate for Payer: Blue Shield of California Commercial |
$524.55
|
| Rate for Payer: Blue Shield of California EPN |
$415.74
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna of CA HMO |
$519.68
|
| Rate for Payer: Cigna of CA PPO |
$600.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.18
|
| Rate for Payer: Dignity Health Media |
$260.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$260.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$260.79
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$609.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$422.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC STR POST TX ENGRAFTMENT
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$306.96 |
| Max. Negotiated Rate |
$1,087.15 |
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.96
|
| Rate for Payer: Multiplan Commercial |
$1,023.20
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
|
|
HC STR POST TX ENGRAFTMENT
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
CPT 81267
|
| Hospital Charge Code |
903902025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$4,999.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,275.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,999.55
|
| Rate for Payer: Blue Distinction Transplant |
$767.40
|
| Rate for Payer: Blue Shield of California Commercial |
$826.23
|
| Rate for Payer: Blue Shield of California EPN |
$654.85
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cigna of CA HMO |
$818.56
|
| Rate for Payer: Cigna of CA PPO |
$946.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.19
|
| Rate for Payer: Dignity Health Media |
$207.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$207.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$207.46
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$959.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$340.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$336.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$336.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.00
|
| Rate for Payer: Multiplan Commercial |
$1,023.20
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$767.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$767.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.04
|
| Rate for Payer: United Healthcare All Other HMO |
$168.04
|
| Rate for Payer: United Healthcare HMO Rider |
$168.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.21
|
| Rate for Payer: Vantage Medical Group Senior |
$207.46
|
|
|
HC STR POST TX MYELOID ENGRAFTMNT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$194.88 |
| Max. Negotiated Rate |
$690.20 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.80
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
|
|
HC STR POST TX MYELOID ENGRAFTMNT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 81268
|
| Hospital Charge Code |
903902027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$194.88 |
| Max. Negotiated Rate |
$2,348.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,261.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,348.98
|
| Rate for Payer: Blue Distinction Transplant |
$487.20
|
| Rate for Payer: Blue Shield of California Commercial |
$524.55
|
| Rate for Payer: Blue Shield of California EPN |
$415.74
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna of CA HMO |
$519.68
|
| Rate for Payer: Cigna of CA PPO |
$600.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.18
|
| Rate for Payer: Dignity Health Media |
$260.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$260.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$260.79
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$609.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$427.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$422.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.46
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.24
|
| Rate for Payer: United Healthcare All Other HMO |
$211.24
|
| Rate for Payer: United Healthcare HMO Rider |
$211.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.87
|
| Rate for Payer: Vantage Medical Group Senior |
$260.79
|
|
|
HC STR PRE TX ENGRAFTMENT
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$182.88 |
| Max. Negotiated Rate |
$2,176.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,877.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,176.25
|
| Rate for Payer: Blue Distinction Transplant |
$457.20
|
| Rate for Payer: Blue Shield of California Commercial |
$492.25
|
| Rate for Payer: Blue Shield of California EPN |
$390.14
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna of CA HMO |
$487.68
|
| Rate for Payer: Cigna of CA PPO |
$563.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.60
|
| Rate for Payer: Dignity Health Media |
$233.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$233.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.07
|
| Rate for Payer: Galaxy Health WC |
$647.70
|
| Rate for Payer: Global Benefits Group Commercial |
$457.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$571.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$382.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$377.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$377.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: Networks By Design Commercial |
$495.30
|
| Rate for Payer: Prime Health Services Commercial |
$647.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$457.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$457.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$188.78
|
| Rate for Payer: United Healthcare HMO Rider |
$188.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC STR PRE TX ENGRAFTMENT
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
903902024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$182.88 |
| Max. Negotiated Rate |
$647.70 |
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.80
|
| Rate for Payer: Galaxy Health WC |
$647.70
|
| Rate for Payer: Global Benefits Group Commercial |
$457.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.88
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: Networks By Design Commercial |
$495.30
|
| Rate for Payer: Prime Health Services Commercial |
$647.70
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.16 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: Cigna of CA PPO |
$1,827.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Media |
$1,264.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,852.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,074.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,074.55
|
| 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 |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,647.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,482.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$592.80 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Cash Price |
$1,111.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.00
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,647.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$941.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$413.28 |
| Max. Negotiated Rate |
$1,463.70 |
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.80
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,148.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.28
|
| Rate for Payer: Multiplan Commercial |
$1,377.60
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| 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 |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,033.20
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cigna of CA PPO |
$1,274.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,291.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| 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 |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,148.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,377.60
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,033.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$861.00
|
| Rate for Payer: United Healthcare All Other HMO |
$861.00
|
| Rate for Payer: United Healthcare HMO Rider |
$861.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$861.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
IP
|
$23,165.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,559.60 |
| Max. Negotiated Rate |
$19,690.25 |
| Rate for Payer: Cash Price |
$10,424.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,266.00
|
| Rate for Payer: Galaxy Health WC |
$19,690.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,899.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,451.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,825.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,559.60
|
| Rate for Payer: Multiplan Commercial |
$18,532.00
|
| Rate for Payer: Networks By Design Commercial |
$15,057.25
|
| Rate for Payer: Prime Health Services Commercial |
$19,690.25
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
OP
|
$23,165.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.89 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,690.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,899.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$10,424.25
|
| Rate for Payer: Cash Price |
$10,424.25
|
| Rate for Payer: Cash Price |
$10,424.25
|
| Rate for Payer: Cigna of CA PPO |
$17,142.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Media |
$10,614.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,329.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,614.79
|
| Rate for Payer: Galaxy Health WC |
$19,690.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,899.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17,373.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,408.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$17,408.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,195.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$17,195.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,451.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,559.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,223.82
|
| Rate for Payer: Multiplan Commercial |
$18,532.00
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$15,057.25
|
| Rate for Payer: Prime Health Services Commercial |
$19,690.25
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,899.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC SUBQ ICD REMOVAL ONLY
|
Facility
|
IP
|
$9,777.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,346.48 |
| Max. Negotiated Rate |
$8,310.45 |
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,910.80
|
| Rate for Payer: Galaxy Health WC |
$8,310.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,866.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,521.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,725.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.48
|
| Rate for Payer: Multiplan Commercial |
$7,821.60
|
| Rate for Payer: Networks By Design Commercial |
$6,355.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,310.45
|
|
|
HC SUBQ ICD REMOVAL ONLY
|
Facility
|
OP
|
$9,777.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$41,690.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,690.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,866.20
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cigna of CA PPO |
$7,234.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Media |
$4,906.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$8,310.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,866.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,332.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,046.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$8,046.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,521.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$7,821.60
|
| Rate for Payer: Networks By Design Commercial |
$6,355.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,310.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,866.20
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
OP
|
$9,777.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.02 |
| Max. Negotiated Rate |
$41,690.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,690.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,866.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: Cigna of CA PPO |
$7,234.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Media |
$4,906.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$8,310.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,866.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,332.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,046.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$8,046.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,948.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,521.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$7,821.60
|
| Rate for Payer: Networks By Design Commercial |
$6,355.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,310.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,866.20
|
| 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 |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
IP
|
$9,777.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,346.48 |
| Max. Negotiated Rate |
$8,310.45 |
| Rate for Payer: Cash Price |
$4,399.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,910.80
|
| Rate for Payer: Galaxy Health WC |
$8,310.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,866.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,521.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,725.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,346.48
|
| Rate for Payer: Multiplan Commercial |
$7,821.60
|
| Rate for Payer: Networks By Design Commercial |
$6,355.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,310.45
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
OP
|
$4,151.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$3,528.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,204.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,486.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,473.17
|
| Rate for Payer: Blue Distinction Transplant |
$2,490.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$1,867.95
|
| Rate for Payer: Cash Price |
$1,867.95
|
| Rate for Payer: Cigna of CA PPO |
$3,071.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Dignity Health Media |
$1,486.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,635.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,007.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,486.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.99
|
| Rate for Payer: Galaxy Health WC |
$3,528.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,490.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,113.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,438.66
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,438.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,408.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,408.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,486.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,768.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,581.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,873.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,992.57
|
| Rate for Payer: Multiplan Commercial |
$3,320.80
|
| Rate for Payer: Networks By Design Commercial |
$2,698.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,528.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,490.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,075.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,075.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,075.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,075.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,230.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,635.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,486.99
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
IP
|
$4,151.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$996.24 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$1,867.95
|
| Rate for Payer: Cash Price |
$1,867.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,660.40
|
| Rate for Payer: Galaxy Health WC |
$3,528.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,490.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,768.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,581.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.24
|
| Rate for Payer: Multiplan Commercial |
$3,320.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,528.35
|
|
