|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
IP
|
$2,758.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$551.60 |
| Max. Negotiated Rate |
$2,482.20 |
| Rate for Payer: Adventist Health Commercial |
$551.60
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,206.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,930.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,103.20
|
| Rate for Payer: Galaxy Health WC |
$2,344.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,654.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,482.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,751.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,627.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.60
|
| Rate for Payer: Multiplan Commercial |
$2,068.50
|
| Rate for Payer: Networks By Design Commercial |
$1,792.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,344.30
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
OP
|
$2,758.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$551.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,206.40
|
| Rate for Payer: Cigna of CA HMO |
$1,765.12
|
| Rate for Payer: Cigna of CA PPO |
$2,040.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,930.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$2,344.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,654.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,482.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,751.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,068.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,792.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,344.30
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,654.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,379.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,379.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,379.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,379.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
OP
|
$2,758.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,130.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$624.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,206.40
|
| Rate for Payer: Cigna of CA HMO |
$1,765.12
|
| Rate for Payer: Cigna of CA PPO |
$2,040.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,930.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$2,344.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,654.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,482.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,751.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,068.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,792.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,344.30
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,654.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,654.80
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC SUBDURAL TAP UNIL/BILAT INIT
|
Facility
|
IP
|
$2,758.00
|
|
|
Service Code
|
CPT 61000
|
| Hospital Charge Code |
900501225
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$551.60 |
| Max. Negotiated Rate |
$2,482.20 |
| Rate for Payer: Adventist Health Commercial |
$551.60
|
| Rate for Payer: Cash Price |
$1,241.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,206.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,930.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,103.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,103.20
|
| Rate for Payer: Galaxy Health WC |
$2,344.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,654.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,482.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,751.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,627.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.60
|
| Rate for Payer: Multiplan Commercial |
$2,068.50
|
| Rate for Payer: Networks By Design Commercial |
$1,792.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,344.30
|
|
|
HC SUB PT/OT CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8993
|
| Hospital Charge Code |
900018415
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8993
|
| Hospital Charge Code |
900018415
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8993
|
| Hospital Charge Code |
900018315
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8993
|
| Hospital Charge Code |
900018315
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8995
|
| Hospital Charge Code |
900018317
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8995
|
| Hospital Charge Code |
900018317
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8995
|
| Hospital Charge Code |
900018417
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8995
|
| Hospital Charge Code |
900018417
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8994
|
| Hospital Charge Code |
900018416
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8994
|
| Hospital Charge Code |
900018316
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SUB PT/OT GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8994
|
| Hospital Charge Code |
900018316
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUB PT/OT GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8994
|
| Hospital Charge Code |
900018416
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
IP
|
$18,706.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,741.20 |
| Max. Negotiated Rate |
$16,835.40 |
| Rate for Payer: Adventist Health Commercial |
$3,741.20
|
| Rate for Payer: Cash Price |
$8,417.70
|
| Rate for Payer: Central Health Plan Commercial |
$14,964.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,094.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,482.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,482.40
|
| Rate for Payer: Galaxy Health WC |
$15,900.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11,223.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,835.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,878.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,036.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,741.20
|
| Rate for Payer: Multiplan Commercial |
$14,029.50
|
| Rate for Payer: Networks By Design Commercial |
$12,158.90
|
| Rate for Payer: Prime Health Services Commercial |
$15,900.10
|
|
|
HC SUBQ ICD LEAD INSERT
|
Facility
|
OP
|
$18,706.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
950442236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.69 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$3,741.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,643.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,216.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$8,417.70
|
| Rate for Payer: Cash Price |
$8,417.70
|
| Rate for Payer: Cash Price |
$8,417.70
|
| Rate for Payer: Central Health Plan Commercial |
$14,964.80
|
| Rate for Payer: Cigna of CA HMO |
$11,971.84
|
| Rate for Payer: Cigna of CA PPO |
$13,842.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,094.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| Rate for Payer: Galaxy Health WC |
$15,900.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11,223.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,835.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$737.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,878.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$814.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,741.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$14,029.50
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$12,158.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$15,900.10
|
| Rate for Payer: Prime Health Services Medicare |
$11,282.14
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,707.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,223.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC SUBQ ICD REMOVAL ONLY
|
Facility
|
IP
|
$7,895.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,579.00 |
| Max. Negotiated Rate |
$7,105.50 |
| Rate for Payer: Adventist Health Commercial |
$1,579.00
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,316.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,526.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,158.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,158.00
|
| Rate for Payer: Galaxy Health WC |
$6,710.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,105.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,013.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,658.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,579.00
|
| Rate for Payer: Multiplan Commercial |
$5,921.25
|
| Rate for Payer: Networks By Design Commercial |
$5,131.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,710.75
|
|
|
HC SUBQ ICD REMOVAL ONLY
|
Facility
|
OP
|
$7,895.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
950442237
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.66 |
| Max. Negotiated Rate |
$46,216.00 |
| Rate for Payer: Adventist Health Commercial |
$1,579.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,806.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,216.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,316.00
|
| Rate for Payer: Cigna of CA HMO |
$5,052.80
|
| Rate for Payer: Cigna of CA PPO |
$5,842.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,526.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$6,710.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,105.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$543.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,013.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$600.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,579.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$5,921.25
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$5,131.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$6,710.75
|
| Rate for Payer: Prime Health Services Medicare |
$5,094.73
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,286.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,737.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,947.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
OP
|
$7,895.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$592.97 |
| Max. Negotiated Rate |
$46,216.00 |
| Rate for Payer: Adventist Health Commercial |
$1,579.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,806.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,216.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,316.00
|
| Rate for Payer: Cigna of CA HMO |
$5,052.80
|
| Rate for Payer: Cigna of CA PPO |
$5,842.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,526.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$6,710.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,105.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$592.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,013.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,579.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$5,921.25
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$5,131.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$6,710.75
|
| Rate for Payer: Prime Health Services Medicare |
$5,094.73
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,286.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,737.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,947.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC SUBQ LEAD REPOSITION
|
Facility
|
IP
|
$7,895.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
950442238
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,579.00 |
| Max. Negotiated Rate |
$7,105.50 |
| Rate for Payer: Adventist Health Commercial |
$1,579.00
|
| Rate for Payer: Cash Price |
$3,552.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,316.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,526.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,158.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,158.00
|
| Rate for Payer: Galaxy Health WC |
$6,710.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,737.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,105.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,013.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,658.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,579.00
|
| Rate for Payer: Multiplan Commercial |
$5,921.25
|
| Rate for Payer: Networks By Design Commercial |
$5,131.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,710.75
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
OP
|
$4,929.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$985.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,565.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,386.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,867.20
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,457.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$2,218.05
|
| Rate for Payer: Cash Price |
$2,218.05
|
| Rate for Payer: Cash Price |
$2,218.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,943.20
|
| Rate for Payer: Cigna of CA HMO |
$3,154.56
|
| Rate for Payer: Cigna of CA PPO |
$3,647.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,450.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$4,189.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,957.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,436.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,129.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,789.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$985.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$3,696.75
|
| Rate for Payer: Multiplan WC |
$2,457.69
|
| Rate for Payer: Networks By Design Commercial |
$3,203.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Preferred Health Network WC |
$2,507.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,189.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,659.92
|
| Rate for Payer: Prime Health Services WC |
$2,432.61
|
| Rate for Payer: Riverside University Health System MISP |
$1,722.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,957.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,464.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,464.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,464.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC SUBSTERN ICD DFIB TEST
|
Facility
|
IP
|
$4,929.00
|
|
|
Service Code
|
CPT 0577T
|
| Hospital Charge Code |
906810577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$985.80 |
| Max. Negotiated Rate |
$4,436.10 |
| Rate for Payer: Adventist Health Commercial |
$985.80
|
| Rate for Payer: Cash Price |
$2,218.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,943.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,450.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,971.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,971.60
|
| Rate for Payer: Galaxy Health WC |
$4,189.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,957.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,436.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,129.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,908.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$985.80
|
| Rate for Payer: Multiplan Commercial |
$3,696.75
|
| Rate for Payer: Networks By Design Commercial |
$3,203.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,189.65
|
|
|
HC SUBSTERN ICD LEAD INSERT
|
Facility
|
IP
|
$64,324.00
|
|
|
Service Code
|
CPT 0572T
|
| Hospital Charge Code |
906810572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,864.80 |
| Max. Negotiated Rate |
$57,891.60 |
| Rate for Payer: Adventist Health Commercial |
$12,864.80
|
| Rate for Payer: Cash Price |
$28,945.80
|
| Rate for Payer: Central Health Plan Commercial |
$51,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45,026.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,729.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25,729.60
|
| Rate for Payer: Galaxy Health WC |
$54,675.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,594.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57,891.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40,845.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,951.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,864.80
|
| Rate for Payer: Multiplan Commercial |
$48,243.00
|
| Rate for Payer: Networks By Design Commercial |
$41,810.60
|
| Rate for Payer: Prime Health Services Commercial |
$54,675.40
|
|
