|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,117.92 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,863.20
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| Rate for Payer: Multiplan Commercial |
$63,726.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$67,709.30 |
| 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 |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$47,794.80
|
| 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 |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| 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 |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59,743.50
|
| 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 |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| 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 |
$63,726.40
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| 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 SUBSTERN ICD LEAD REMOVE
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,117.92 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,863.20
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| Rate for Payer: Multiplan Commercial |
$63,726.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
|
|
HC SUBSTERN ICD LEAD REMOVE
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0573T
|
| Hospital Charge Code |
906810573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$67,709.30 |
| 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 |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$47,794.80
|
| 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 |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| 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 |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59,743.50
|
| 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 |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| 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 |
$63,726.40
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| 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 |
$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 SUBSTERN ICD LEAD REPOS
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$67,709.30 |
| 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 |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$47,794.80
|
| 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 |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| 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 |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59,743.50
|
| 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 |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| 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 |
$63,726.40
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| 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 |
$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 SUBSTERN ICD LEAD REPOS
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0574T
|
| Hospital Charge Code |
906810574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,117.92 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,863.20
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| Rate for Payer: Multiplan Commercial |
$63,726.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,429.68 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.80
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.68
|
| Rate for Payer: Multiplan Commercial |
$4,765.60
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| 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 |
$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 |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,574.20
|
| 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 |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cigna of CA PPO |
$4,408.18
|
| 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 |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,467.75
|
| 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 |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,429.68
|
| 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 |
$4,765.60
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,574.20
|
| 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 SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,117.92 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,863.20
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| Rate for Payer: Multiplan Commercial |
$63,726.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$103,995.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$47,794.80
|
| 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 |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA PPO |
$58,946.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Media |
$41,105.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,492.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$41,105.24
|
| Rate for Payer: Galaxy Health WC |
$67,709.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47,794.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59,743.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$67,412.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$67,412.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66,590.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$66,590.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,131.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,349.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,105.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,117.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,081.02
|
| Rate for Payer: Multiplan Commercial |
$63,726.40
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: Networks By Design Commercial |
$51,777.70
|
| Rate for Payer: Prime Health Services Commercial |
$67,709.30
|
| Rate for Payer: Prime Health Services WC |
$55,623.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,794.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$103,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92,797.00
|
| Rate for Payer: United Healthcare HMO Rider |
$80,182.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$420.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.23
|
| Rate for Payer: Blue Shield of California EPN |
$60.42
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$420.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Blue Distinction Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$76.23
|
| Rate for Payer: Blue Shield of California EPN |
$60.42
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
IP
|
$172.62
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.43 |
| Max. Negotiated Rate |
$12,398.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,398.00
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cigna of CA HMO |
$120.83
|
| Rate for Payer: Cigna of CA PPO |
$120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.05
|
| Rate for Payer: Galaxy Health WC |
$146.73
|
| Rate for Payer: Global Benefits Group Commercial |
$103.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.43
|
| Rate for Payer: Multiplan Commercial |
$138.10
|
| Rate for Payer: Networks By Design Commercial |
$86.31
|
| Rate for Payer: Prime Health Services Commercial |
$146.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.18
|
| Rate for Payer: United Healthcare All Other HMO |
$63.66
|
| Rate for Payer: United Healthcare HMO Rider |
$62.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.96
|
|
|
HC SUPPORT KNEE HINGE MD 18-20.5"
|
Facility
|
OP
|
$172.62
|
|
|
Service Code
|
CPT L1833
|
| Hospital Charge Code |
901698810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.43 |
| Max. Negotiated Rate |
$972.99 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.01
|
| Rate for Payer: Blue Distinction Transplant |
$103.57
|
| Rate for Payer: Blue Shield of California Commercial |
$122.91
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cigna of CA HMO |
$120.83
|
| Rate for Payer: Cigna of CA PPO |
$120.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.73
|
| Rate for Payer: Dignity Health Media |
$146.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.05
|
| Rate for Payer: Galaxy Health WC |
$146.73
|
| Rate for Payer: Global Benefits Group Commercial |
$103.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$972.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.43
|
| Rate for Payer: Multiplan Commercial |
$138.10
|
| Rate for Payer: Networks By Design Commercial |
$86.31
|
| Rate for Payer: Prime Health Services Commercial |
$146.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.31
|
| Rate for Payer: United Healthcare All Other HMO |
$86.31
|
| Rate for Payer: United Healthcare HMO Rider |
$86.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.73
|
| Rate for Payer: Vantage Medical Group Senior |
$146.73
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$101.29 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$340.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.29
|
| Rate for Payer: Blue Distinction Transplant |
$397.20
|
| Rate for Payer: Blue Shield of California Commercial |
$391.24
|
| Rate for Payer: Blue Shield of California EPN |
$310.48
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna of CA HMO |
$423.68
|
| Rate for Payer: Cigna of CA PPO |
$489.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: Dignity Health Media |
$149.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$496.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$245.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$242.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$149.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$529.60
|
| Rate for Payer: Networks By Design Commercial |
$430.30
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.88
|
| Rate for Payer: Multiplan Commercial |
$529.60
|
| Rate for Payer: Networks By Design Commercial |
$430.30
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
OP
|
$2,569.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$266.49 |
| Max. Negotiated Rate |
$2,183.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,530.61
|
| Rate for Payer: Blue Distinction Transplant |
$1,541.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,518.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,204.86
|
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: Cigna of CA HMO |
$1,644.16
|
| Rate for Payer: Cigna of CA PPO |
$1,901.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$2,183.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,926.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.04
|
| Rate for Payer: Heritage Provider Network Transplant |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$431.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,713.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$2,055.20
|
| Rate for Payer: Networks By Design Commercial |
$1,669.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,541.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,541.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
IP
|
$2,569.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$616.56 |
| Max. Negotiated Rate |
$2,183.65 |
| Rate for Payer: Cash Price |
$1,156.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,027.60
|
| Rate for Payer: Galaxy Health WC |
$2,183.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,541.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,713.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.56
|
| Rate for Payer: Multiplan Commercial |
$2,055.20
|
| Rate for Payer: Networks By Design Commercial |
$1,669.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,183.65
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.16 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.60
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.16
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.16 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$858.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,112.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$719.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.90
|
| Rate for Payer: Blue Distinction Transplant |
$785.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cigna of CA PPO |
$968.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,112.65
|
| Rate for Payer: Dignity Health Media |
$1,112.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,112.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$523.60
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$981.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.16
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: Networks By Design Commercial |
$850.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$785.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.50
|
| Rate for Payer: United Healthcare All Other HMO |
$654.50
|
| Rate for Payer: United Healthcare HMO Rider |
$654.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,112.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,112.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,112.65
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
IP
|
$10,792.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,590.08 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$4,856.40
|
| Rate for Payer: Cash Price |
$4,856.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,316.80
|
| Rate for Payer: Galaxy Health WC |
$9,173.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,198.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,111.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,590.08
|
| Rate for Payer: Multiplan Commercial |
$8,633.60
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,173.20
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
OP
|
$10,792.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,590.08 |
| Max. Negotiated Rate |
$9,173.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,078.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,173.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,935.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,935.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,429.87
|
| Rate for Payer: Blue Distinction Transplant |
$6,475.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$4,856.40
|
| Rate for Payer: Cash Price |
$4,856.40
|
| Rate for Payer: Cigna of CA PPO |
$7,986.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,173.20
|
| Rate for Payer: Dignity Health Media |
$9,173.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,173.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,316.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,316.80
|
| Rate for Payer: Galaxy Health WC |
$9,173.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,475.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,094.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,198.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,111.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,590.08
|
| Rate for Payer: Multiplan Commercial |
$8,633.60
|
| Rate for Payer: Networks By Design Commercial |
$7,014.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,173.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,396.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,173.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,173.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9,173.20
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.16 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.60
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.16
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
|
