|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$220.64 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.64
|
| Rate for Payer: Blue Shield of California Commercial |
$131.12
|
| Rate for Payer: Blue Shield of California EPN |
$86.63
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.16
|
| Rate for Payer: EPIC Health Plan Senior |
$22.34
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.10
|
| Rate for Payer: United Healthcare All Other HMO |
$18.10
|
| Rate for Payer: United Healthcare HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.32
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
OP
|
$14,691.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,938.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,080.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,018.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$6,610.95
|
| Rate for Payer: Cash Price |
$6,610.95
|
| Rate for Payer: Cash Price |
$6,610.95
|
| Rate for Payer: Cigna of CA HMO |
$9,402.24
|
| Rate for Payer: Cigna of CA PPO |
$10,871.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,487.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,487.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,876.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,876.40
|
| Rate for Payer: Galaxy Health WC |
$12,487.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,814.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,093.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,283.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,283.70
|
| Rate for Payer: Multiplan Commercial |
$11,752.80
|
| Rate for Payer: Networks By Design Commercial |
$9,549.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,814.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,487.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,487.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,487.35
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
IP
|
$14,691.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,938.20 |
| Max. Negotiated Rate |
$12,487.35 |
| Rate for Payer: Adventist Health Commercial |
$2,938.20
|
| Rate for Payer: Cash Price |
$6,610.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,876.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,876.40
|
| Rate for Payer: Galaxy Health WC |
$12,487.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,814.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,798.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,597.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,093.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.84
|
| Rate for Payer: Multiplan Commercial |
$11,752.80
|
| Rate for Payer: Networks By Design Commercial |
$9,549.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,487.35
|
|
|
HC IMPL AGA DUCT OCCLUDER II
|
Facility
|
OP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$9,696.80 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,274.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,556.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,607.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8,419.10
|
| Rate for Payer: Blue Shield of California EPN |
$5,544.29
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna of CA HMO |
$7,985.60
|
| Rate for Payer: Cigna of CA PPO |
$7,985.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,696.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,563.20
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,346.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,061.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,985.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,985.60
|
| Rate for Payer: Multiplan Commercial |
$9,126.40
|
| Rate for Payer: Networks By Design Commercial |
$5,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,844.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,844.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,281.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4,167.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4,077.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,736.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,696.80
|
|
|
HC IMPL AGA DUCT OCCLUDER II
|
Facility
|
IP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cash Price |
$5,133.60
|
| Rate for Payer: Cigna of CA HMO |
$7,985.60
|
| Rate for Payer: Cigna of CA PPO |
$7,985.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,563.20
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,346.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,061.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,737.92
|
| Rate for Payer: Multiplan Commercial |
$9,126.40
|
| Rate for Payer: Networks By Design Commercial |
$5,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,281.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4,167.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4,077.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,736.12
|
|
|
HC IMPL AGA VAS PLUG II OCCL
|
Facility
|
IP
|
$3,244.80
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.96 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$648.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,460.16
|
| Rate for Payer: Cash Price |
$1,460.16
|
| Rate for Payer: Cigna of CA HMO |
$2,271.36
|
| Rate for Payer: Cigna of CA PPO |
$2,271.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,297.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1,297.92
|
| Rate for Payer: Galaxy Health WC |
$2,758.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1,946.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,164.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.75
|
| Rate for Payer: Multiplan Commercial |
$2,595.84
|
| Rate for Payer: Networks By Design Commercial |
$1,622.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,758.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,185.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,159.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.67
|
|
|
HC IMPL AGA VAS PLUG II OCCL
|
Facility
|
OP
|
$3,244.80
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.96 |
| Max. Negotiated Rate |
$2,758.08 |
| Rate for Payer: Adventist Health Commercial |
$648.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,784.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,433.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,879.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,394.66
|
| Rate for Payer: Blue Shield of California EPN |
$1,576.97
|
| Rate for Payer: Cash Price |
$1,460.16
|
| Rate for Payer: Cigna of CA HMO |
$2,271.36
|
| Rate for Payer: Cigna of CA PPO |
$2,271.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,758.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,758.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,297.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1,297.92
|
| Rate for Payer: Galaxy Health WC |
$2,758.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1,946.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,164.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,271.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,271.36
|
| Rate for Payer: Multiplan Commercial |
$2,595.84
|
| Rate for Payer: Networks By Design Commercial |
$1,622.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,758.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,946.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,946.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,185.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,159.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,758.08
|
| Rate for Payer: Vantage Medical Group Senior |
$2,758.08
|
|
|
HC IMPL AGA VSD OCCL DEVICE
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$12,750.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,688.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,070.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,290.00
|
| Rate for Payer: Cash Price |
$6,750.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.00
|
| Rate for Payer: Multiplan Commercial |
$12,000.00
|
| Rate for Payer: Networks By Design Commercial |
$7,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.00
|
|
|
HC IMPL AGA VSD OCCL DEVICE
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,750.00
|
| Rate for Payer: Cash Price |
$6,750.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.00
|
| Rate for Payer: Multiplan Commercial |
$12,000.00
|
| Rate for Payer: Networks By Design Commercial |
$7,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$938.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.56
|
| Rate for Payer: Blue Shield of California EPN |
$787.32
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
|
IP
|
$2,172.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna of CA HMO |
$1,520.40
|
| Rate for Payer: Cigna of CA PPO |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,344.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.28
|
| Rate for Payer: Multiplan Commercial |
$1,737.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other HMO |
$793.43
|
| Rate for Payer: United Healthcare HMO Rider |
$776.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.33
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
|
OP
|
$2,172.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,846.20 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,194.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,629.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,258.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,602.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,055.59
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna of CA HMO |
$1,520.40
|
| Rate for Payer: Cigna of CA PPO |
$1,520.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,846.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,846.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,344.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,520.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,520.40
|
| Rate for Payer: Multiplan Commercial |
$1,737.60
|
| Rate for Payer: Networks By Design Commercial |
$1,086.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,303.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,303.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other HMO |
$793.43
|
| Rate for Payer: United Healthcare HMO Rider |
$776.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,846.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,846.20
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
OP
|
$21,327.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.51 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,265.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: Cigna of CA HMO |
$13,649.28
|
| Rate for Payer: Cigna of CA PPO |
$15,781.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$18,127.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,796.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$356.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,225.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,118.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$17,061.60
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$13,862.55
|
| Rate for Payer: Prime Health Services Commercial |
$18,127.95
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,796.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
IP
|
$21,327.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,265.40 |
| Max. Negotiated Rate |
$18,127.95 |
| Rate for Payer: Adventist Health Commercial |
$4,265.40
|
| Rate for Payer: Cash Price |
$9,597.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,530.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,530.80
|
| Rate for Payer: Galaxy Health WC |
$18,127.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,796.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,225.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,125.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,201.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,118.48
|
| Rate for Payer: Multiplan Commercial |
$17,061.60
|
| Rate for Payer: Networks By Design Commercial |
$13,862.55
|
| Rate for Payer: Prime Health Services Commercial |
$18,127.95
|
|
|
HC IMPLANT INSERTION NON-BIODEG
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
950510099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
|
|
HC IMPLANT INSERTION NON-BIODEG
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
950510099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.06 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.43
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$246.40
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC IMPLANT REMOVAL NON-BIODEG
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
950510101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.88 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC IMPLANT REMOVAL NON-BIODEG
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
950510101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC IMPLANT REMOVE & REINSERTION
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
950510103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC IMPLANT REMOVE & REINSERTION
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
950510103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC IMPL GORE SEPTALOCC CARDIOFORM
|
Facility
|
IP
|
$17,493.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,498.60 |
| Max. Negotiated Rate |
$14,869.05 |
| Rate for Payer: Adventist Health Commercial |
$3,498.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,871.85
|
| Rate for Payer: Cash Price |
$7,871.85
|
| Rate for Payer: Cigna of CA HMO |
$12,245.10
|
| Rate for Payer: Cigna of CA PPO |
$12,245.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,997.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,997.20
|
| Rate for Payer: Galaxy Health WC |
$14,869.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,667.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,664.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,828.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,198.32
|
| Rate for Payer: Multiplan Commercial |
$13,994.40
|
| Rate for Payer: Networks By Design Commercial |
$8,746.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,869.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,565.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6,390.19
|
| Rate for Payer: United Healthcare HMO Rider |
$6,252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,728.96
|
|
|
HC IMPL GORE SEPTALOCC CARDIOFORM
|
Facility
|
OP
|
$17,493.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,498.60 |
| Max. Negotiated Rate |
$14,869.05 |
| Rate for Payer: Adventist Health Commercial |
$3,498.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,869.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,621.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,119.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,131.95
|
| Rate for Payer: Blue Shield of California Commercial |
$12,909.83
|
| Rate for Payer: Blue Shield of California EPN |
$8,501.60
|
| Rate for Payer: Cash Price |
$7,871.85
|
| Rate for Payer: Cigna of CA HMO |
$12,245.10
|
| Rate for Payer: Cigna of CA PPO |
$12,245.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,869.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,869.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,869.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,997.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,997.20
|
| Rate for Payer: Galaxy Health WC |
$14,869.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,667.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,664.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,828.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,198.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,245.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,245.10
|
| Rate for Payer: Multiplan Commercial |
$13,994.40
|
| Rate for Payer: Networks By Design Commercial |
$8,746.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,869.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,495.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,495.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,565.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6,390.19
|
| Rate for Payer: United Healthcare HMO Rider |
$6,252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,728.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,869.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,869.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14,869.05
|
|
