|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.17
|
| Rate for Payer: Blue Shield of California Commercial |
$238.39
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$170.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.74
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$263.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$263.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.00
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$263.50
|
| Rate for Payer: Vantage Medical Group Senior |
$263.50
|
|
|
HC I-125 SEED
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
|
|
HC I-125 SEED
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$223.55 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.19
|
| Rate for Payer: Blue Shield of California Commercial |
$133.34
|
| Rate for Payer: Blue Shield of California Commercial |
$202.25
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.10
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$222.07
|
| Rate for Payer: Blue Shield of California Commercial |
$336.82
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.03 |
| Max. Negotiated Rate |
$773.95 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$515.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$469.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.03
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$469.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.95
|
| Rate for Payer: EPIC Health Plan Senior |
$515.97
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$769.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$469.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$656.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$591.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$628.54
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$469.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.97
|
| Rate for Payer: Vantage Medical Group Senior |
$469.06
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
OP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$4,890.05 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$953.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,110.79
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$953.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,027.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.47
|
| Rate for Payer: EPIC Health Plan Senior |
$1,048.31
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,562.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$774.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$953.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,653.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$875.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,334.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,200.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,277.03
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,451.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,451.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$953.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.31
|
| Rate for Payer: Vantage Medical Group Senior |
$953.01
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
IP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,150.60 |
| Max. Negotiated Rate |
$4,890.05 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,916.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,424.06
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,027.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,653.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,394.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.72
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.85
|
| Rate for Payer: Blue Shield of California Commercial |
$62.31
|
| Rate for Payer: Blue Shield of California Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.27
|
| Rate for Payer: EPIC Health Plan Senior |
$22.85
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.83
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.85
|
| Rate for Payer: Vantage Medical Group Senior |
$22.85
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Blue Shield of California Commercial |
$113.81
|
| Rate for Payer: Blue Shield of California Commercial |
$75.04
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
OP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$388.09 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.99
|
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: Cigna of CA HMO |
$292.21
|
| Rate for Payer: Cigna of CA PPO |
$337.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$388.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$388.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$388.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.61
|
| Rate for Payer: Multiplan Commercial |
$365.26
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.29
|
| Rate for Payer: United Healthcare All Other HMO |
$228.29
|
| Rate for Payer: United Healthcare HMO Rider |
$228.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$388.09
|
| Rate for Payer: Vantage Medical Group Senior |
$388.09
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
IP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$388.09 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.58
|
| Rate for Payer: Multiplan Commercial |
$365.26
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
IP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$462.93 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$381.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$345.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$321.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.71
|
| Rate for Payer: Multiplan Commercial |
$435.70
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
OP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$462.93 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$299.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.48
|
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: Cigna of CA HMO |
$348.56
|
| Rate for Payer: Cigna of CA PPO |
$403.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$462.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$462.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$381.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$345.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$321.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$381.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$381.23
|
| Rate for Payer: Multiplan Commercial |
$435.70
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.31
|
| Rate for Payer: United Healthcare All Other HMO |
$272.31
|
| Rate for Payer: United Healthcare HMO Rider |
$272.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.93
|
| Rate for Payer: Vantage Medical Group Senior |
$462.93
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$7,408.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,323.00 |
| Rate for Payer: Adventist Health Commercial |
$1,481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,210.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,296.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,074.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,556.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Cigna of CA HMO |
$4,741.12
|
| Rate for Payer: Cigna of CA PPO |
$5,481.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,296.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,296.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,296.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,963.20
|
| Rate for Payer: Galaxy Health WC |
$6,296.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,444.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$912.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,704.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,031.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,370.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,777.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,185.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,185.60
|
| Rate for Payer: Multiplan Commercial |
$5,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,815.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,444.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,296.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,296.80
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$7,408.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,481.60 |
| Max. Negotiated Rate |
$6,296.80 |
| Rate for Payer: Adventist Health Commercial |
$1,481.60
|
| Rate for Payer: Cash Price |
$3,333.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,963.20
|
| Rate for Payer: Galaxy Health WC |
$6,296.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,444.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,704.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,370.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,777.92
|
| Rate for Payer: Multiplan Commercial |
$5,926.40
|
| Rate for Payer: Networks By Design Commercial |
$4,815.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,296.80
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
OP
|
$6,128.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,225.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,225.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,208.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,370.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,596.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Cigna of CA HMO |
$3,921.92
|
| Rate for Payer: Cigna of CA PPO |
$4,534.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,208.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,208.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,208.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,289.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,451.20
|
| Rate for Payer: Galaxy Health WC |
$5,208.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,676.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,505.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,891.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,702.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,615.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,289.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,289.60
|
| Rate for Payer: Multiplan Commercial |
$4,902.40
|
| Rate for Payer: Networks By Design Commercial |
$3,983.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,676.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,064.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,208.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,208.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,208.80
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
IP
|
$6,128.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,225.60 |
| Max. Negotiated Rate |
$5,208.80 |
| Rate for Payer: Adventist Health Commercial |
$1,225.60
|
| Rate for Payer: Cash Price |
$2,757.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,289.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,451.20
|
| Rate for Payer: Galaxy Health WC |
$5,208.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,676.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,891.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,615.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.72
|
| Rate for Payer: Multiplan Commercial |
$4,902.40
|
| Rate for Payer: Networks By Design Commercial |
$3,983.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,208.80
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
IP
|
$5,822.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,164.40 |
| Max. Negotiated Rate |
$4,948.70 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,075.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,328.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,328.80
|
| Rate for Payer: Galaxy Health WC |
$4,948.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,493.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,696.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,434.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.28
|
| Rate for Payer: Multiplan Commercial |
$4,657.60
|
| Rate for Payer: Networks By Design Commercial |
$3,784.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
OP
|
$5,822.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.07 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,164.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Cash Price |
$2,619.90
|
| Rate for Payer: Cigna of CA HMO |
$3,726.08
|
| Rate for Payer: Cigna of CA PPO |
$4,308.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,075.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$4,948.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,493.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$252.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,696.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,056.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$4,657.60
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,784.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,948.70
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,493.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,911.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
IP
|
$92,988.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906811425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,597.60 |
| Max. Negotiated Rate |
$79,039.80 |
| Rate for Payer: Adventist Health Commercial |
$18,597.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,091.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37,195.20
|
| Rate for Payer: Galaxy Health WC |
$79,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55,792.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,047.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,862.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,317.12
|
| Rate for Payer: Multiplan Commercial |
$74,390.40
|
| Rate for Payer: Networks By Design Commercial |
$60,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$79,039.80
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
OP
|
$92,988.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906811425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.39 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Commercial |
$18,597.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,608.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,164.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cigna of CA HMO |
$59,512.32
|
| Rate for Payer: Cigna of CA PPO |
$68,811.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,469.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,608.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,091.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,204.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31,469.86
|
| Rate for Payer: Galaxy Health WC |
$79,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55,792.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$46,918.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,047.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,052.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,317.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,047.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,336.01
|
| Rate for Payer: Multiplan Commercial |
$74,390.40
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: Networks By Design Commercial |
$60,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$79,039.80
|
| Rate for Payer: Prime Health Services WC |
$44,978.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55,792.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$28,608.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28,608.96
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$92,988.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906811426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,597.60 |
| Max. Negotiated Rate |
$79,039.80 |
| Rate for Payer: Adventist Health Commercial |
$18,597.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,091.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37,195.20
|
| Rate for Payer: Galaxy Health WC |
$79,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55,792.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,047.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,862.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,317.12
|
| Rate for Payer: Multiplan Commercial |
$74,390.40
|
| Rate for Payer: Networks By Design Commercial |
$60,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$79,039.80
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$92,988.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906811426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$545.41 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Commercial |
$18,597.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,164.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cash Price |
$41,844.60
|
| Rate for Payer: Cigna of CA HMO |
$59,512.32
|
| Rate for Payer: Cigna of CA PPO |
$68,811.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,091.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,612.68
|
| Rate for Payer: EPIC Health Plan Senior |
$44,408.45
|
| Rate for Payer: Galaxy Health WC |
$79,039.80
|
| Rate for Payer: Global Benefits Group Commercial |
$55,792.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$66,208.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$545.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,047.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$616.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,519.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,317.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,867.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$74,390.40
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: Networks By Design Commercial |
$60,442.20
|
| Rate for Payer: Prime Health Services Commercial |
$79,039.80
|
| Rate for Payer: Prime Health Services WC |
$64,245.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55,792.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,371.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
|
HC ICD INSERT/REPL + DUAL LEADS
|
Facility
|
OP
|
$95,252.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906811378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,503.62 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Commercial |
$19,050.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,164.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$42,863.40
|
| Rate for Payer: Cash Price |
$42,863.40
|
| Rate for Payer: Cash Price |
$42,863.40
|
| Rate for Payer: Cigna of CA HMO |
$60,961.28
|
| Rate for Payer: Cigna of CA PPO |
$70,486.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66,676.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,612.68
|
| Rate for Payer: EPIC Health Plan Senior |
$44,408.45
|
| Rate for Payer: Galaxy Health WC |
$80,964.20
|
| Rate for Payer: Global Benefits Group Commercial |
$57,151.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$66,208.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,503.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60,485.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,700.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,519.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,860.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,867.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$76,201.60
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: Networks By Design Commercial |
$61,913.80
|
| Rate for Payer: Prime Health Services Commercial |
$80,964.20
|
| Rate for Payer: Prime Health Services WC |
$64,245.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57,151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$47,626.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,371.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
