|
HC IONTOPHORESIS 15 MIN MCARE COMM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900407033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC IP ADULT/PEDS DIALYSIS TREATMENT
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100100
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$1,458.06 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,071.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,003.44
|
| Rate for Payer: Cash Price |
$898.70
|
| Rate for Payer: Cash Price |
$898.70
|
| Rate for Payer: Cigna of CA HMO |
$1,045.76
|
| Rate for Payer: Cigna of CA PPO |
$1,209.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$980.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$980.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.00
|
| Rate for Payer: United Healthcare All Other HMO |
$817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$817.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC IP ADULT/PEDS DIALYSIS TREATMENT
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100100
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$1,388.90 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$898.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$653.60
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
|
|
HC IPV INITIAL
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800320
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cigna of CA HMO |
$378.24
|
| Rate for Payer: Cigna of CA PPO |
$437.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC IPV INITIAL
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800320
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
|
|
HC IPV SUB
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800321
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$365.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
|
|
HC IPV SUB
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800321
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cash Price |
$325.05
|
| Rate for Payer: Cigna of CA HMO |
$378.24
|
| Rate for Payer: Cigna of CA PPO |
$437.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
900910437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
900910437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$119.75
|
| Rate for Payer: Blue Shield of California EPN |
$79.12
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.74
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Vantage Medical Group Senior |
$8.74
|
|
|
HC IRON TOTAL
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC IRON TOTAL
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.97
|
| Rate for Payer: Blue Shield of California Commercial |
$96.34
|
| Rate for Payer: Blue Shield of California EPN |
$63.65
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.65
|
| 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 |
$171.95
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| 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 |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| 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 |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| 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 IRRADIATION PROCEDURE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cigna of CA HMO |
$596.48
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$576.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Cigna of CA HMO |
$1,239.68
|
| Rate for Payer: Cigna of CA PPO |
$1,433.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,646.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,162.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,291.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$1,549.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,259.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,646.45
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,162.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$968.50
|
| Rate for Payer: United Healthcare All Other HMO |
$968.50
|
| Rate for Payer: United Healthcare HMO Rider |
$968.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$968.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.40 |
| Max. Negotiated Rate |
$1,646.45 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.80
|
| Rate for Payer: EPIC Health Plan Senior |
$774.80
|
| Rate for Payer: Galaxy Health WC |
$1,646.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,162.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,291.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,199.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$1,549.60
|
| Rate for Payer: Networks By Design Commercial |
$1,259.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,646.45
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cigna of CA HMO |
$208.64
|
| Rate for Payer: Cigna of CA PPO |
$241.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$130.40
|
| Rate for Payer: Galaxy Health WC |
$277.10
|
| Rate for Payer: Global Benefits Group Commercial |
$195.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$217.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.24
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Networks By Design Commercial |
$211.90
|
| Rate for Payer: Prime Health Services Commercial |
$277.10
|
|
