|
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 |
$123.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.97
|
| 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 |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| 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 |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
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 |
$317.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.75
|
| 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 |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.32
|
| 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 |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| 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 |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,935.00
|
| 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 |
$4,476.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,159.50
|
| 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 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 |
$165.49 |
| Max. Negotiated Rate |
$7,196.06 |
| 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 |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,523.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$3,172.50
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| 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/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,476.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,692.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Cash Price |
$2,955.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,596.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,626.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,170.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,874.53
|
| 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 |
$8,309.24 |
| Rate for Payer: Adventist Health Commercial |
$1,313.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,596.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| 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/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,170.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,413.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,345.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,748.11
|
| 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 |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$6,567.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,596.90
|
| 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 |
$4,170.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,874.53
|
| 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
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$8,309.24 |
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$5,581.95
|
| Rate for Payer: Adventist Health Commercial |
$2,692.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,118.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,596.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: Global Benefits Group Commercial |
$3,940.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,170.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,413.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,345.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,748.11
|
| 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: TriValley Medical Group Commercial/Senior |
$3,940.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC REMOVAL OF JP DRAIN CATHETER
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
906812000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$2,478.60 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,041.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.40
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,851.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,720.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.84
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
|
|
HC REMOVAL OF JP DRAIN CATHETER
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
906812000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,871.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna of CA HMO |
$1,866.24
|
| Rate for Payer: Cigna of CA PPO |
$2,157.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,041.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,851.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,458.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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 |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,702.80
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,337.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,392.36
|
| 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 |
$10,502.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,702.80
|
| 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 |
$13,337.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,392.36
|
| 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 REMOVE ARM/ELBOW LESION LT 3 CM
|
Facility
|
IP
|
$5,968.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
904000005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,193.60 |
| Max. Negotiated Rate |
$5,072.80 |
| Rate for Payer: Adventist Health Commercial |
$1,193.60
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,387.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,387.20
|
| Rate for Payer: Galaxy Health WC |
$5,072.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,580.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,789.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,521.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,432.32
|
| Rate for Payer: Multiplan Commercial |
$4,774.40
|
| Rate for Payer: Networks By Design Commercial |
$3,879.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,072.80
|
|
|
HC REMOVE ARM/ELBOW LESION LT 3 CM
|
Facility
|
OP
|
$5,968.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
904000005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.22 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,193.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cigna of CA HMO |
$3,819.52
|
| Rate for Payer: Cigna of CA PPO |
$4,416.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$5,072.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,580.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,789.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,432.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$4,774.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$3,879.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,072.80
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,580.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$6,902.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.81 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,380.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: Cigna of CA HMO |
$4,417.28
|
| Rate for Payer: Cigna of CA PPO |
$5,107.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,831.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$5,866.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,141.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,382.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,656.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$5,521.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$4,486.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,866.70
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,141.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,451.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,451.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,451.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,451.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$6,902.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$210.81 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$5,866.70
|
| Rate for Payer: Adventist Health Commercial |
$2,829.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,872.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: Cigna of CA HMO |
$4,417.28
|
| Rate for Payer: Cigna of CA PPO |
$5,107.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,831.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: Global Benefits Group Commercial |
$4,141.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,382.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,656.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$5,521.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$4,486.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,866.70
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,141.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,141.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$6,902.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,831.40
|
| 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 |
$4,382.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,072.18
|
| 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
|
|
|
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: Galaxy Health WC |
$5,866.70
|
| Rate for Payer: Adventist Health Commercial |
$1,380.40
|
| Rate for Payer: Cash Price |
$3,105.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,831.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,760.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,760.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,141.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,382.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,072.18
|
| 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
|
|
|
HC REMOVE CERCLAGE SUTURE
|
Facility
|
IP
|
$7,912.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
902400749
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,582.40 |
| Max. Negotiated Rate |
$6,725.20 |
| Rate for Payer: Adventist Health Commercial |
$1,582.40
|
| Rate for Payer: Cash Price |
$3,560.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,538.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,164.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,164.80
|
| Rate for Payer: Galaxy Health WC |
$6,725.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,747.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,024.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,668.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.88
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: Networks By Design Commercial |
$5,142.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,725.20
|
|
|
HC REMOVE CERCLAGE SUTURE
|
Facility
|
OP
|
$7,912.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
902400749
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$226.43 |
| Max. Negotiated Rate |
$6,869.74 |
| Rate for Payer: Adventist Health Commercial |
$1,582.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$925.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,560.40
|
| Rate for Payer: Cash Price |
$3,560.40
|
| Rate for Payer: Cash Price |
$3,560.40
|
| Rate for Payer: Cash Price |
$3,560.40
|
| Rate for Payer: Cigna of CA HMO |
$5,063.68
|
| Rate for Payer: Cigna of CA PPO |
$5,854.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,538.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,725.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,747.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,024.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: Networks By Design Commercial |
$5,142.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,725.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,747.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,747.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
|
IP
|
$6,860.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,372.00 |
| Max. Negotiated Rate |
$5,831.00 |
| Rate for Payer: Adventist Health Commercial |
$1,372.00
|
| Rate for Payer: Cash Price |
$3,087.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,744.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,744.00
|
| Rate for Payer: Galaxy Health WC |
$5,831.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,116.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,356.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,646.40
|
| Rate for Payer: Multiplan Commercial |
$5,488.00
|
| Rate for Payer: Networks By Design Commercial |
$4,459.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,831.00
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
|
OP
|
$6,860.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,222.79 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,372.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,087.00
|
| Rate for Payer: Cash Price |
$3,087.00
|
| Rate for Payer: Cash Price |
$3,087.00
|
| Rate for Payer: Cigna of CA HMO |
$4,390.40
|
| Rate for Payer: Cigna of CA PPO |
$5,076.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$5,831.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,116.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,222.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,356.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,382.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,646.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$5,488.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,459.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,831.00
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,116.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,430.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
|
OP
|
$6,765.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$709.28 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cigna of CA HMO |
$4,329.60
|
| Rate for Payer: Cigna of CA PPO |
$5,006.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,378.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7,585.79
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,309.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$709.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$802.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,654.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,689.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,240.87
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
| Rate for Payer: Prime Health Services WC |
$10,186.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,059.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,382.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,896.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
