|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
911801002
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$481.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna of CA HMO |
$469.76
|
| Rate for Payer: Cigna of CA PPO |
$543.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$329.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC REFILL/MAINTAIN IMPL PUMP/RES
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
901200118
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Senior |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.16
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: Networks By Design Commercial |
$477.10
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$700.40 |
| Rate for Payer: EPIC Health Plan Senior |
$329.60
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.60
|
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$549.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$510.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
|
|
HC REFILL/MAINTAIN PORTABLE PUMP
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
911801001
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$164.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$540.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna of CA HMO |
$527.36
|
| Rate for Payer: Cigna of CA PPO |
$609.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$700.40
|
| Rate for Payer: Global Benefits Group Commercial |
$494.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$329.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$549.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: Networks By Design Commercial |
$535.60
|
| Rate for Payer: Prime Health Services Commercial |
$700.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$494.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$494.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$553.72
|
| Rate for Payer: Blue Shield of California Commercial |
$705.53
|
| Rate for Payer: Blue Shield of California EPN |
$464.62
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$553.72
|
| Rate for Payer: Blue Shield of California Commercial |
$705.53
|
| Rate for Payer: Blue Shield of California EPN |
$464.62
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Adventist Health Commercial |
$2,380.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: Cigna of CA HMO |
$7,616.00
|
| Rate for Payer: Cigna of CA PPO |
$8,806.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,937.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,140.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,950.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$11,900.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$10,115.00 |
| Rate for Payer: Adventist Health Commercial |
$2,380.00
|
| Rate for Payer: Cash Price |
$5,355.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,760.00
|
| Rate for Payer: Galaxy Health WC |
$10,115.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,140.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,937.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,533.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,366.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$9,520.00
|
| Rate for Payer: Networks By Design Commercial |
$7,735.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,115.00
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$60.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.07
|
| 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 |
$90.89
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| 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 |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| 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 REM AUTON ALG INSLN DATA COLL
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$36.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.27
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC REM AUTON ALG INSLN DATA COLL
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$7,050.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,410.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,624.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,329.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: Cigna of CA HMO |
$4,512.00
|
| Rate for Payer: Cigna of CA PPO |
$5,217.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$5,992.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,230.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,702.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,692.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$5,640.00
|
| Rate for Payer: Networks By Design Commercial |
$4,582.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,992.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,230.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,230.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
IP
|
$8,294.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,658.80 |
| Max. Negotiated Rate |
$7,049.90 |
| Rate for Payer: Adventist Health Commercial |
$1,658.80
|
| Rate for Payer: Cash Price |
$3,732.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,317.60
|
| Rate for Payer: Galaxy Health WC |
$7,049.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,976.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,532.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,160.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,133.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.56
|
| Rate for Payer: Multiplan Commercial |
$6,635.20
|
| Rate for Payer: Networks By Design Commercial |
$5,391.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,049.90
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$8,294.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$7,049.90 |
| Rate for Payer: Adventist Health Commercial |
$1,658.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,440.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,093.35
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,732.30
|
| Rate for Payer: Cash Price |
$3,732.30
|
| Rate for Payer: Cash Price |
$3,732.30
|
| Rate for Payer: Cigna of CA HMO |
$5,308.16
|
| Rate for Payer: Cigna of CA PPO |
$6,137.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$7,049.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,976.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,532.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$6,635.20
|
| Rate for Payer: Networks By Design Commercial |
$5,391.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,049.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,976.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,976.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
IP
|
$7,050.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$5,992.50 |
| Rate for Payer: Adventist Health Commercial |
$1,410.00
|
| Rate for Payer: Cash Price |
$3,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,820.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,820.00
|
| Rate for Payer: Galaxy Health WC |
$5,992.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,230.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,702.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,686.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,363.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,692.00
|
| Rate for Payer: Multiplan Commercial |
$5,640.00
|
| Rate for Payer: Networks By Design Commercial |
$4,582.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,992.50
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$6,567.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,313.40 |
| Max. Negotiated Rate |
$5,581.95 |
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,626.80
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,502.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,064.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Multiplan Commercial |
$5,253.60
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
OP
|
$6,567.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$613.28 |
| Max. Negotiated Rate |
$7,979.39 |
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Cigna of CA HMO |
$4,202.88
|
| Rate for Payer: Cigna of CA PPO |
$4,859.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,380.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$5,253.60
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$4,268.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,581.95
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,940.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,283.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$21,004.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,200.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,853.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,552.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,753.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$9,451.80
|
| Rate for Payer: Cash Price |
$9,451.80
|
| Rate for Payer: Cash Price |
$9,451.80
|
| Rate for Payer: Cigna of CA HMO |
$13,442.56
|
| Rate for Payer: Cigna of CA PPO |
$15,542.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,853.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,853.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,853.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,401.60
|
| Rate for Payer: Galaxy Health WC |
$17,853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12,602.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,009.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,001.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,702.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,702.80
|
| Rate for Payer: Multiplan Commercial |
$16,803.20
|
| Rate for Payer: Networks By Design Commercial |
$13,652.60
|
| Rate for Payer: Prime Health Services Commercial |
$17,853.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,853.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,853.40
|
| Rate for Payer: Vantage Medical Group Senior |
$17,853.40
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$21,004.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,200.80 |
| Max. Negotiated Rate |
$17,853.40 |
| Rate for Payer: Adventist Health Commercial |
$4,200.80
|
| Rate for Payer: Cash Price |
$9,451.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,401.60
|
| Rate for Payer: Galaxy Health WC |
$17,853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$12,602.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,009.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,002.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,001.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.96
|
| Rate for Payer: Multiplan Commercial |
$16,803.20
|
| Rate for Payer: Networks By Design Commercial |
$13,652.60
|
| Rate for Payer: Prime Health Services Commercial |
$17,853.40
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$20,413.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,082.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,309.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$9,185.85
|
| Rate for Payer: Cash Price |
$9,185.85
|
| Rate for Payer: Cash Price |
$9,185.85
|
| Rate for Payer: Cigna of CA HMO |
$13,064.32
|
| Rate for Payer: Cigna of CA PPO |
$15,105.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,351.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,165.20
|
| Rate for Payer: Galaxy Health WC |
$17,351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,247.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,615.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,635.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,899.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,289.10
|
| Rate for Payer: Multiplan Commercial |
$16,330.40
|
| Rate for Payer: Networks By Design Commercial |
$13,268.45
|
| Rate for Payer: Prime Health Services Commercial |
$17,351.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$17,351.05
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$20,413.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,082.60 |
| Max. Negotiated Rate |
$17,351.05 |
| Rate for Payer: Adventist Health Commercial |
$4,082.60
|
| Rate for Payer: Cash Price |
$9,185.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,165.20
|
| Rate for Payer: Galaxy Health WC |
$17,351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12,247.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,615.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,777.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,635.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,899.12
|
| Rate for Payer: Multiplan Commercial |
$16,330.40
|
| Rate for Payer: Networks By Design Commercial |
$13,268.45
|
| Rate for Payer: Prime Health Services Commercial |
$17,351.05
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$6,902.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,380.40 |
| Max. Negotiated Rate |
$5,866.70 |
| Rate for Payer: Adventist Health Commercial |
$1,380.40
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,760.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,760.80
|
| Rate for Payer: Galaxy Health WC |
$5,866.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,141.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,603.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,629.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,272.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,656.48
|
| Rate for Payer: Multiplan Commercial |
$5,521.60
|
| Rate for Payer: Networks By Design Commercial |
$4,486.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,866.70
|
|
