|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
|
HC PHOSPHATIDYLGLYCEROL (PG)
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
900910939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.04
|
| Rate for Payer: Blue Shield of California Commercial |
$32.27
|
| Rate for Payer: Blue Shield of California Commercial |
$117.09
|
| Rate for Payer: Blue Shield of California Commercial |
$48.79
|
| Rate for Payer: Blue Shield of California Commercial |
$177.04
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.26
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: EPIC Health Plan Senior |
$18.17
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.14
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.38
|
| Rate for Payer: United Healthcare All Other HMO |
$13.38
|
| Rate for Payer: United Healthcare All Other HMO |
$13.38
|
| Rate for Payer: United Healthcare HMO Rider |
$13.38
|
| Rate for Payer: United Healthcare HMO Rider |
$13.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.37
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California Commercial |
$49.79
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California Commercial |
$75.28
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.54
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
| Rate for Payer: Vantage Medical Group Senior |
$5.78
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
900910215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Senior |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC PHOSPHORUS
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC PHOSPHORUS
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
900910252
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.85
|
| Rate for Payer: Blue Shield of California Commercial |
$14.29
|
| Rate for Payer: Blue Shield of California Commercial |
$120.58
|
| Rate for Payer: Blue Shield of California Commercial |
$21.61
|
| Rate for Payer: Blue Shield of California Commercial |
$79.75
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.35
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare HMO Rider |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.21
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.74
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$778.13
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna of CA HMO |
$960.00
|
| Rate for Payer: Cigna of CA PPO |
$1,110.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$778.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$707.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,167.19
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,160.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$952.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$707.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$760.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$891.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$947.90
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Multiplan WC |
$1,110.63
|
| Rate for Payer: Networks By Design Commercial |
$975.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
| Rate for Payer: Prime Health Services WC |
$1,099.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.00
|
| Rate for Payer: United Healthcare All Other HMO |
$750.00
|
| Rate for Payer: United Healthcare HMO Rider |
$750.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$750.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$707.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,061.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$778.13
|
| Rate for Payer: Vantage Medical Group Senior |
$707.39
|
|
|
HC PHOTOCOAGULATION
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
900501743
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$600.00
|
| Rate for Payer: Galaxy Health WC |
$1,275.00
|
| Rate for Payer: Global Benefits Group Commercial |
$900.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$952.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$885.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,200.00
|
| Rate for Payer: Networks By Design Commercial |
$975.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,275.00
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$6,508.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,301.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,601.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Cigna of CA HMO |
$4,165.12
|
| Rate for Payer: Cigna of CA PPO |
$4,815.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,555.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,243.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6,162.09
|
| Rate for Payer: Galaxy Health WC |
$5,531.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,187.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,972.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,601.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,132.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,842.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,506.55
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: Multiplan WC |
$9,485.01
|
| Rate for Payer: Networks By Design Commercial |
$4,230.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,531.80
|
| Rate for Payer: Prime Health Services WC |
$9,388.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,904.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,254.00
|
| 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: Upland Medical Group Pediatric |
$5,601.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5,601.90
|
|
|
HC PHOTOPHERESIS
|
Facility
|
OP
|
$6,508.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,301.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,601.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Cigna of CA HMO |
$4,165.12
|
| Rate for Payer: Cigna of CA PPO |
$4,815.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,162.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,555.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,243.14
|
| Rate for Payer: EPIC Health Plan Senior |
$6,162.09
|
| Rate for Payer: Galaxy Health WC |
$5,531.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9,187.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,972.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,601.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,132.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,623.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,842.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,506.55
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: Multiplan WC |
$9,485.01
|
| Rate for Payer: Networks By Design Commercial |
$4,230.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,531.80
|
| Rate for Payer: Prime Health Services WC |
$9,388.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,904.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,254.00
|
| 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: Upland Medical Group Pediatric |
$5,601.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,402.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,162.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5,601.90
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$6,508.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
945000104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$5,531.80 |
| Rate for Payer: Adventist Health Commercial |
$1,301.60
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,555.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,603.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,603.20
|
| Rate for Payer: Galaxy Health WC |
$5,531.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,132.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,839.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.92
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: Networks By Design Commercial |
$4,230.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,531.80
|
|
|
HC PHOTOPHERESIS
|
Facility
|
IP
|
$6,508.00
|
|
|
Service Code
|
CPT 36522
|
| Hospital Charge Code |
946100104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$5,531.80 |
| Rate for Payer: Adventist Health Commercial |
$1,301.60
|
| Rate for Payer: Cash Price |
$2,928.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,555.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,603.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,603.20
|
| Rate for Payer: Galaxy Health WC |
$5,531.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,132.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,839.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.92
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: Networks By Design Commercial |
$4,230.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,531.80
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
IP
|
$72,520.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,504.00 |
| Max. Negotiated Rate |
$61,642.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50,764.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46,050.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,786.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
|
|
HC PHRNC NRV STIM INSRT GEN, LEAD
|
Facility
|
OP
|
$72,520.00
|
|
|
Service Code
|
CPT 0424T
|
| Hospital Charge Code |
906810424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,886.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54,390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,231.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Cigna of CA HMO |
$46,412.80
|
| Rate for Payer: Cigna of CA PPO |
$53,664.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,642.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61,642.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50,764.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46,050.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,324.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,786.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,764.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,764.00
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,512.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$36,260.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,642.00
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
OP
|
$15,409.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,081.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,081.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,097.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,474.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,556.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$6,934.05
|
| Rate for Payer: Cash Price |
$6,934.05
|
| Rate for Payer: Cigna of CA HMO |
$9,861.76
|
| Rate for Payer: Cigna of CA PPO |
$11,402.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,097.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,097.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,097.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,786.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,163.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,163.60
|
| Rate for Payer: Galaxy Health WC |
$13,097.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,245.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,784.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,593.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,091.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,786.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,786.30
|
| Rate for Payer: Multiplan Commercial |
$12,327.20
|
| Rate for Payer: Networks By Design Commercial |
$10,015.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,097.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,704.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,097.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,097.65
|
| Rate for Payer: Vantage Medical Group Senior |
$13,097.65
|
|
|
HC PHRNC NRV STIM INSRT TRNSVNS LEAD
|
Facility
|
IP
|
$15,409.00
|
|
|
Service Code
|
CPT 0425T
|
| Hospital Charge Code |
906810425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,081.80 |
| Max. Negotiated Rate |
$13,097.65 |
| Rate for Payer: Adventist Health Commercial |
$3,081.80
|
| Rate for Payer: Cash Price |
$6,934.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,786.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,163.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,163.60
|
| Rate for Payer: Galaxy Health WC |
$13,097.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,245.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,784.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,091.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,698.16
|
| Rate for Payer: Multiplan Commercial |
$12,327.20
|
| Rate for Payer: Networks By Design Commercial |
$10,015.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,097.65
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
OP
|
$72,520.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39,886.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54,390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,231.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Cigna of CA HMO |
$46,412.80
|
| Rate for Payer: Cigna of CA PPO |
$53,664.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$61,642.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61,642.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50,764.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46,050.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,324.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,786.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,764.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,764.00
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,512.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$36,260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61,642.00
|
| Rate for Payer: Vantage Medical Group Senior |
$61,642.00
|
|
|
HC PHRNC NRV STIM REMOVAL, REPL GEN
|
Facility
|
IP
|
$72,520.00
|
|
|
Service Code
|
CPT 0431T
|
| Hospital Charge Code |
906810431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,504.00 |
| Max. Negotiated Rate |
$61,642.00 |
| Rate for Payer: Adventist Health Commercial |
$14,504.00
|
| Rate for Payer: Cash Price |
$32,634.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50,764.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,008.00
|
| Rate for Payer: EPIC Health Plan Senior |
$29,008.00
|
| Rate for Payer: Galaxy Health WC |
$61,642.00
|
| Rate for Payer: Global Benefits Group Commercial |
$43,512.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46,050.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,786.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,404.80
|
| Rate for Payer: Multiplan Commercial |
$58,016.00
|
| Rate for Payer: Networks By Design Commercial |
$47,138.00
|
| Rate for Payer: Prime Health Services Commercial |
$61,642.00
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
IP
|
$48,014.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,602.80 |
| Max. Negotiated Rate |
$40,811.90 |
| Rate for Payer: Adventist Health Commercial |
$9,602.80
|
| Rate for Payer: Cash Price |
$21,606.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,609.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.60
|
| Rate for Payer: Galaxy Health WC |
$40,811.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,488.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,328.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.36
|
| Rate for Payer: Multiplan Commercial |
$38,411.20
|
| Rate for Payer: Networks By Design Commercial |
$31,209.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,811.90
|
|
|
HC PHRNC NRV STIM REMOVAL , REPL TRNSVNS LEAD
|
Facility
|
OP
|
$48,014.00
|
|
|
Service Code
|
CPT 0426T
|
| Hospital Charge Code |
906810426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,602.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,811.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,407.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,010.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$21,606.30
|
| Rate for Payer: Cash Price |
$21,606.30
|
| Rate for Payer: Cigna of CA HMO |
$30,728.96
|
| Rate for Payer: Cigna of CA PPO |
$35,530.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,811.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,811.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,811.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,609.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,205.60
|
| Rate for Payer: Galaxy Health WC |
$40,811.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,808.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,488.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,429.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,328.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,523.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,609.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,609.80
|
| Rate for Payer: Multiplan Commercial |
$38,411.20
|
| Rate for Payer: Networks By Design Commercial |
$31,209.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,811.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,808.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,007.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,811.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,811.90
|
| Rate for Payer: Vantage Medical Group Senior |
$40,811.90
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,979.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,846.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,626.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,920.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC PHRNC NRV STIM REMOVAL TRNSVNS
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0430T
|
| Hospital Charge Code |
906810430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,979.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,626.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
OP
|
$7,841.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,312.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,880.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,231.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Cigna of CA HMO |
$5,018.24
|
| Rate for Payer: Cigna of CA PPO |
$5,802.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,664.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,664.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,488.70
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,979.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,846.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,626.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.70
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,704.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,920.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,664.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,664.85
|
|
|
HC PHRNC NRV STIM RMVL GEN
|
Facility
|
IP
|
$7,841.00
|
|
|
Service Code
|
CPT 0428T
|
| Hospital Charge Code |
906810428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.20 |
| Max. Negotiated Rate |
$6,664.85 |
| Rate for Payer: Adventist Health Commercial |
$1,568.20
|
| Rate for Payer: Cash Price |
$3,528.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,488.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,136.40
|
| Rate for Payer: Galaxy Health WC |
$6,664.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,979.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,626.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.84
|
| Rate for Payer: Multiplan Commercial |
$6,272.80
|
| Rate for Payer: Networks By Design Commercial |
$5,096.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,664.85
|
|
|
HC PHRNC NRV STIM RMVL GEN AND LEAD
|
Facility
|
IP
|
$7,631.00
|
|
|
Service Code
|
CPT 33278
|
| Hospital Charge Code |
906819772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,526.20 |
| Max. Negotiated Rate |
$6,486.35 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,341.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.40
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,845.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,502.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.44
|
| Rate for Payer: Multiplan Commercial |
$6,104.80
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
|
