|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
IP
|
$15,412.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,698.88 |
| Max. Negotiated Rate |
$13,100.20 |
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.80
|
| Rate for Payer: Galaxy Health WC |
$13,100.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,279.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,871.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.88
|
| Rate for Payer: Multiplan Commercial |
$12,329.60
|
| Rate for Payer: Networks By Design Commercial |
$10,017.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,100.20
|
|
|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
OP
|
$15,412.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$333.16 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,247.20
|
| 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 |
$6,935.40
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cigna of CA PPO |
$11,404.88
|
| 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 |
$13,100.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,247.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,559.00
|
| 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 |
$10,279.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.88
|
| 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 |
$12,329.60
|
| Rate for Payer: Networks By Design Commercial |
$10,017.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,100.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,247.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,247.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
OP
|
$15,412.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.16 |
| Max. Negotiated Rate |
$17,408.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,247.20
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cigna of CA PPO |
$11,404.88
|
| 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 |
$13,100.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,247.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,559.00
|
| 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 |
$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 |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,279.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.88
|
| 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 |
$12,329.60
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$10,017.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,100.20
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,247.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,706.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,706.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,706.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,706.00
|
| 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 TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
IP
|
$15,412.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,698.88 |
| Max. Negotiated Rate |
$13,100.20 |
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,164.80
|
| Rate for Payer: Galaxy Health WC |
$13,100.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,279.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,871.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.88
|
| Rate for Payer: Multiplan Commercial |
$12,329.60
|
| Rate for Payer: Networks By Design Commercial |
$10,017.80
|
| Rate for Payer: Prime Health Services Commercial |
$13,100.20
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$14,678.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,522.72 |
| Max. Negotiated Rate |
$12,476.30 |
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,871.20
|
| Rate for Payer: Galaxy Health WC |
$12,476.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,806.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,592.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,522.72
|
| Rate for Payer: Multiplan Commercial |
$11,742.40
|
| Rate for Payer: Networks By Design Commercial |
$9,540.70
|
| Rate for Payer: Prime Health Services Commercial |
$12,476.30
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$14,678.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.16 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,806.80
|
| 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 |
$6,605.10
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Cigna of CA PPO |
$10,861.72
|
| 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 |
$12,476.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,806.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,008.50
|
| 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 |
$9,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,522.72
|
| 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 |
$11,742.40
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$9,540.70
|
| Rate for Payer: Prime Health Services Commercial |
$12,476.30
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,806.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$14,678.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$495.16 |
| Max. Negotiated Rate |
$17,408.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,806.80
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Cigna of CA PPO |
$10,861.72
|
| 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 |
$12,476.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,806.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,008.50
|
| 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 |
$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 |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,614.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,522.72
|
| 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 |
$11,742.40
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: Networks By Design Commercial |
$9,540.70
|
| Rate for Payer: Prime Health Services Commercial |
$12,476.30
|
| Rate for Payer: Prime Health Services WC |
$14,363.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,806.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,339.00
|
| 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 TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$14,678.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,522.72 |
| Max. Negotiated Rate |
$12,476.30 |
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,871.20
|
| Rate for Payer: Galaxy Health WC |
$12,476.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,806.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,790.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,592.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,522.72
|
| Rate for Payer: Multiplan Commercial |
$11,742.40
|
| Rate for Payer: Networks By Design Commercial |
$9,540.70
|
| Rate for Payer: Prime Health Services Commercial |
$12,476.30
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
OP
|
$3,072.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,843.20
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cigna of CA PPO |
$2,273.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$2,611.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,843.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,304.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,333.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,333.58
|
| 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 |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,049.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$2,457.60
|
| Rate for Payer: Networks By Design Commercial |
$1,996.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,611.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,843.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,536.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,536.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,536.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
IP
|
$3,072.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.28 |
| Max. Negotiated Rate |
$2,611.20 |
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,228.80
|
| Rate for Payer: Galaxy Health WC |
$2,611.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,843.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,049.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,170.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.28
|
| Rate for Payer: Multiplan Commercial |
$2,457.60
|
| Rate for Payer: Networks By Design Commercial |
$1,996.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,611.20
|
|
|
HC TENOTOMY PERCUT TOE SNGL TENDN
|
Facility
|
OP
|
$8,359.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
900501072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.54 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,015.40
|
| Rate for Payer: Cash Price |
$3,761.55
|
| Rate for Payer: Cash Price |
$3,761.55
|
| Rate for Payer: Cash Price |
$3,761.55
|
| Rate for Payer: Cigna of CA PPO |
$6,185.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$7,105.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,015.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,269.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,575.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,006.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$6,687.20
|
| Rate for Payer: Networks By Design Commercial |
$5,433.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,105.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,015.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC TENOTOMY PERCUT TOE SNGL TENDN
|
Facility
|
IP
|
$8,359.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
900501072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,006.16 |
| Max. Negotiated Rate |
$7,105.15 |
| Rate for Payer: Cash Price |
$3,761.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,343.60
|
| Rate for Payer: Galaxy Health WC |
$7,105.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,015.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,575.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,184.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,006.16
|
| Rate for Payer: Multiplan Commercial |
$6,687.20
|
| Rate for Payer: Networks By Design Commercial |
$5,433.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,105.15
|
|
|
HC TESTICULAR SCAN
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$330.72 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.20
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.72
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Networks By Design Commercial |
$895.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
|
|
HC TESTICULAR SCAN
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,171.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,124.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$821.01
|
| Rate for Payer: Blue Distinction Transplant |
$826.80
|
| Rate for Payer: Blue Shield of California Commercial |
$814.40
|
| Rate for Payer: Blue Shield of California EPN |
$646.28
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cigna of CA HMO |
$881.92
|
| Rate for Payer: Cigna of CA PPO |
$1,019.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,033.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Networks By Design Commercial |
$895.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$235.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$214.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.50
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Media |
$25.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$41.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC TEST URINE VOLUME
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.22
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Media |
$3.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.58
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC THEOPHYLLINE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
900910457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$129.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$117.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.11
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Media |
$14.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN MCAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
901300061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC THERAPEUTIC ACTIVITY 15 MIN MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
901300061
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$184.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Media |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC THERAPEUTIC ACTIVITY 15MIN MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
900400073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$184.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO |
$197.12
|
| Rate for Payer: Cigna of CA PPO |
$227.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$261.80
|
| Rate for Payer: Dignity Health Media |
$261.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$261.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$261.80
|
| Rate for Payer: Vantage Medical Group Senior |
$261.80
|
|
|
HC THERAPEUTIC ACTIVITY 15MIN MCAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
900400073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$261.80 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.92
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC THERAPEUTIC ASPIR BRONCH INITL
|
Facility
|
IP
|
$4,130.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
900803510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$991.20 |
| Max. Negotiated Rate |
$3,510.50 |
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,652.00
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.20
|
| Rate for Payer: Multiplan Commercial |
$3,304.00
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
|
|
HC THERAPEUTIC ASPIR BRONCH INITL
|
Facility
|
OP
|
$4,130.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
900803510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,043.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,411.92
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cash Price |
$1,858.50
|
| Rate for Payer: Cigna of CA HMO |
$2,643.20
|
| Rate for Payer: Cigna of CA PPO |
$3,056.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$3,510.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,097.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,435.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,754.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$3,304.00
|
| Rate for Payer: Networks By Design Commercial |
$2,684.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,510.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,478.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,478.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,065.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,065.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,065.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,065.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC THERAPEUTIC INJECTION IA
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
909020041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$362.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.56
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
|
