|
HC TARSORRHAPHY
|
Facility
|
IP
|
$7,319.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,463.80 |
| Max. Negotiated Rate |
$6,587.10 |
| Rate for Payer: Adventist Health Commercial |
$1,463.80
|
| Rate for Payer: Cash Price |
$3,293.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,927.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,927.60
|
| Rate for Payer: Galaxy Health WC |
$6,221.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,587.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,647.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,318.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,463.80
|
| Rate for Payer: Multiplan Commercial |
$5,489.25
|
| Rate for Payer: Networks By Design Commercial |
$4,757.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,221.15
|
|
|
HC TAVI TAVR
|
Facility
|
IP
|
$148,359.00
|
|
| Hospital Charge Code |
906811453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29,671.80 |
| Max. Negotiated Rate |
$133,523.10 |
| Rate for Payer: Adventist Health Commercial |
$29,671.80
|
| Rate for Payer: Cash Price |
$66,761.55
|
| Rate for Payer: Central Health Plan Commercial |
$118,687.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103,851.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59,343.60
|
| Rate for Payer: Galaxy Health WC |
$126,105.15
|
| Rate for Payer: Global Benefits Group Commercial |
$89,015.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$133,523.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94,207.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,531.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,671.80
|
| Rate for Payer: Multiplan Commercial |
$111,269.25
|
| Rate for Payer: Networks By Design Commercial |
$96,433.35
|
| Rate for Payer: Prime Health Services Commercial |
$126,105.15
|
|
|
HC TAVI TAVR
|
Facility
|
OP
|
$148,359.00
|
|
| Hospital Charge Code |
906811453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$133,523.10 |
| Rate for Payer: Adventist Health Commercial |
$29,671.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126,105.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81,597.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111,269.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,835.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,300.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$66,761.55
|
| Rate for Payer: Cash Price |
$66,761.55
|
| Rate for Payer: Central Health Plan Commercial |
$118,687.20
|
| Rate for Payer: Cigna of CA HMO |
$94,949.76
|
| Rate for Payer: Cigna of CA PPO |
$109,785.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126,105.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$126,105.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126,105.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103,851.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59,343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59,343.60
|
| Rate for Payer: Galaxy Health WC |
$126,105.15
|
| Rate for Payer: Global Benefits Group Commercial |
$89,015.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$133,523.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94,207.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53,854.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,531.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,671.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103,851.30
|
| Rate for Payer: Multiplan Commercial |
$111,269.25
|
| Rate for Payer: Networks By Design Commercial |
$96,433.35
|
| Rate for Payer: Prime Health Services Commercial |
$126,105.15
|
| Rate for Payer: Riverside University Health System MISP |
$59,343.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89,015.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$74,179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$74,179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$74,179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74,179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126,105.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126,105.15
|
| Rate for Payer: Vantage Medical Group Senior |
$126,105.15
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$52,946.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,589.20 |
| Max. Negotiated Rate |
$47,651.40 |
| Rate for Payer: Adventist Health Commercial |
$10,589.20
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: Central Health Plan Commercial |
$42,356.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,062.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,178.40
|
| Rate for Payer: EPIC Health Plan Senior |
$21,178.40
|
| Rate for Payer: Galaxy Health WC |
$45,004.10
|
| Rate for Payer: Global Benefits Group Commercial |
$31,767.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$47,651.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,620.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,238.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,589.20
|
| Rate for Payer: Multiplan Commercial |
$39,709.50
|
| Rate for Payer: Networks By Design Commercial |
$34,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$45,004.10
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$52,946.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$806.82 |
| Max. Negotiated Rate |
$47,651.40 |
| Rate for Payer: Adventist Health Commercial |
$10,589.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,636.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,798.69
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: Central Health Plan Commercial |
$42,356.80
|
| Rate for Payer: Cigna of CA HMO |
$33,885.44
|
| Rate for Payer: Cigna of CA PPO |
$39,180.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,062.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$45,004.10
|
| Rate for Payer: Global Benefits Group Commercial |
$31,767.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$47,651.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,620.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,589.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$39,709.50
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$34,414.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$45,004.10
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,767.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,473.00
|
| 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: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
OP
|
$53,762.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$48,385.80 |
| Rate for Payer: Adventist Health Commercial |
$10,752.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45,697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,569.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,321.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Central Health Plan Commercial |
$43,009.60
|
| Rate for Payer: Cigna of CA HMO |
$34,407.68
|
| Rate for Payer: Cigna of CA PPO |
$39,783.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45,697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,697.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45,697.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,633.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,504.80
|
| Rate for Payer: EPIC Health Plan Senior |
$21,504.80
|
| Rate for Payer: Galaxy Health WC |
$45,697.70
|
| Rate for Payer: Global Benefits Group Commercial |
$32,257.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$48,385.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$420.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,138.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$464.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,752.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37,633.40
|
| Rate for Payer: Multiplan Commercial |
$40,321.50
|
| Rate for Payer: Networks By Design Commercial |
$34,945.30
|
| Rate for Payer: Prime Health Services Commercial |
$45,697.70
|
| Rate for Payer: Riverside University Health System MISP |
$21,504.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,257.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,881.00
|
| 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 |
$45,697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,697.70
|
| Rate for Payer: Vantage Medical Group Senior |
$45,697.70
|
|
|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
IP
|
$53,762.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,752.40 |
| Max. Negotiated Rate |
$48,385.80 |
| Rate for Payer: Adventist Health Commercial |
$10,752.40
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Central Health Plan Commercial |
$43,009.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,633.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,504.80
|
| Rate for Payer: EPIC Health Plan Senior |
$21,504.80
|
| Rate for Payer: Galaxy Health WC |
$45,697.70
|
| Rate for Payer: Global Benefits Group Commercial |
$32,257.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$48,385.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,138.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,752.40
|
| Rate for Payer: Multiplan Commercial |
$40,321.50
|
| Rate for Payer: Networks By Design Commercial |
$34,945.30
|
| Rate for Payer: Prime Health Services Commercial |
$45,697.70
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$52,214.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,029.93 |
| Max. Negotiated Rate |
$46,992.60 |
| Rate for Payer: Adventist Health Commercial |
$10,442.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,381.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28,717.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,160.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$23,496.30
|
| Rate for Payer: Cash Price |
$23,496.30
|
| Rate for Payer: Cash Price |
$23,496.30
|
| Rate for Payer: Central Health Plan Commercial |
$41,771.20
|
| Rate for Payer: Cigna of CA HMO |
$33,416.96
|
| Rate for Payer: Cigna of CA PPO |
$38,638.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,381.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,381.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,381.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,549.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,885.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20,885.60
|
| Rate for Payer: Galaxy Health WC |
$44,381.90
|
| Rate for Payer: Global Benefits Group Commercial |
$31,328.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$46,992.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,029.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,155.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,242.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,806.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,442.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,549.80
|
| Rate for Payer: Multiplan Commercial |
$39,160.50
|
| Rate for Payer: Networks By Design Commercial |
$33,939.10
|
| Rate for Payer: Prime Health Services Commercial |
$44,381.90
|
| Rate for Payer: Riverside University Health System MISP |
$20,885.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,328.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,107.00
|
| 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 |
$44,381.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,381.90
|
| Rate for Payer: Vantage Medical Group Senior |
$44,381.90
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
IP
|
$52,214.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,442.80 |
| Max. Negotiated Rate |
$46,992.60 |
| Rate for Payer: Adventist Health Commercial |
$10,442.80
|
| Rate for Payer: Cash Price |
$23,496.30
|
| Rate for Payer: Central Health Plan Commercial |
$41,771.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,549.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,885.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20,885.60
|
| Rate for Payer: Galaxy Health WC |
$44,381.90
|
| Rate for Payer: Global Benefits Group Commercial |
$31,328.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$46,992.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,155.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,806.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,442.80
|
| Rate for Payer: Multiplan Commercial |
$39,160.50
|
| Rate for Payer: Networks By Design Commercial |
$33,939.10
|
| Rate for Payer: Prime Health Services Commercial |
$44,381.90
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$54,131.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,239.97 |
| Max. Negotiated Rate |
$48,717.90 |
| Rate for Payer: Adventist Health Commercial |
$10,826.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,011.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,772.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,598.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$24,358.95
|
| Rate for Payer: Cash Price |
$24,358.95
|
| Rate for Payer: Cash Price |
$24,358.95
|
| Rate for Payer: Central Health Plan Commercial |
$43,304.80
|
| Rate for Payer: Cigna of CA HMO |
$34,643.84
|
| Rate for Payer: Cigna of CA PPO |
$40,056.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,011.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$46,011.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46,011.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,891.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$21,652.40
|
| Rate for Payer: Galaxy Health WC |
$46,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32,478.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$48,717.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,239.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,373.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,474.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,937.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,826.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37,891.70
|
| Rate for Payer: Multiplan Commercial |
$40,598.25
|
| Rate for Payer: Networks By Design Commercial |
$35,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$46,011.35
|
| Rate for Payer: Riverside University Health System MISP |
$21,652.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,478.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$27,065.50
|
| 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 |
$46,011.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46,011.35
|
| Rate for Payer: Vantage Medical Group Senior |
$46,011.35
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$54,131.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,826.20 |
| Max. Negotiated Rate |
$48,717.90 |
| Rate for Payer: Adventist Health Commercial |
$10,826.20
|
| Rate for Payer: Cash Price |
$24,358.95
|
| Rate for Payer: Central Health Plan Commercial |
$43,304.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,891.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$21,652.40
|
| Rate for Payer: Galaxy Health WC |
$46,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32,478.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$48,717.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,373.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,937.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,826.20
|
| Rate for Payer: Multiplan Commercial |
$40,598.25
|
| Rate for Payer: Networks By Design Commercial |
$35,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$46,011.35
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$48,275.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,655.00 |
| Max. Negotiated Rate |
$43,447.50 |
| Rate for Payer: Adventist Health Commercial |
$9,655.00
|
| Rate for Payer: Cash Price |
$21,723.75
|
| Rate for Payer: Central Health Plan Commercial |
$38,620.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,792.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,310.00
|
| Rate for Payer: Galaxy Health WC |
$41,033.75
|
| Rate for Payer: Global Benefits Group Commercial |
$28,965.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,447.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,654.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,482.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.00
|
| Rate for Payer: Multiplan Commercial |
$36,206.25
|
| Rate for Payer: Networks By Design Commercial |
$31,378.75
|
| Rate for Payer: Prime Health Services Commercial |
$41,033.75
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$48,275.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.76 |
| Max. Negotiated Rate |
$43,447.50 |
| Rate for Payer: Adventist Health Commercial |
$9,655.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,033.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,551.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,206.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$21,723.75
|
| Rate for Payer: Cash Price |
$21,723.75
|
| Rate for Payer: Cash Price |
$21,723.75
|
| Rate for Payer: Central Health Plan Commercial |
$38,620.00
|
| Rate for Payer: Cigna of CA HMO |
$30,896.00
|
| Rate for Payer: Cigna of CA PPO |
$35,723.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,033.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,033.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,033.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,792.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,310.00
|
| Rate for Payer: Galaxy Health WC |
$41,033.75
|
| Rate for Payer: Global Benefits Group Commercial |
$28,965.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,447.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$370.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,654.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$409.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,482.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33,792.50
|
| Rate for Payer: Multiplan Commercial |
$36,206.25
|
| Rate for Payer: Networks By Design Commercial |
$31,378.75
|
| Rate for Payer: Prime Health Services Commercial |
$41,033.75
|
| Rate for Payer: Riverside University Health System MISP |
$19,310.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,965.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,137.50
|
| 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 |
$41,033.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,033.75
|
| Rate for Payer: Vantage Medical Group Senior |
$41,033.75
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$57,033.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$487.95 |
| Max. Negotiated Rate |
$51,329.70 |
| Rate for Payer: Adventist Health Commercial |
$11,406.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,478.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,368.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,774.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$25,664.85
|
| Rate for Payer: Cash Price |
$25,664.85
|
| Rate for Payer: Cash Price |
$25,664.85
|
| Rate for Payer: Central Health Plan Commercial |
$45,626.40
|
| Rate for Payer: Cigna of CA HMO |
$36,501.12
|
| Rate for Payer: Cigna of CA PPO |
$42,204.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,478.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,478.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48,478.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22,813.20
|
| Rate for Payer: Galaxy Health WC |
$48,478.05
|
| Rate for Payer: Global Benefits Group Commercial |
$34,219.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,329.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$487.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,649.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,406.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,923.10
|
| Rate for Payer: Multiplan Commercial |
$42,774.75
|
| Rate for Payer: Networks By Design Commercial |
$37,071.45
|
| Rate for Payer: Prime Health Services Commercial |
$48,478.05
|
| Rate for Payer: Riverside University Health System MISP |
$22,813.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,219.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,516.50
|
| 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 |
$48,478.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,478.05
|
| Rate for Payer: Vantage Medical Group Senior |
$48,478.05
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$57,033.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,406.60 |
| Max. Negotiated Rate |
$51,329.70 |
| Rate for Payer: Adventist Health Commercial |
$11,406.60
|
| Rate for Payer: Cash Price |
$25,664.85
|
| Rate for Payer: Central Health Plan Commercial |
$45,626.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22,813.20
|
| Rate for Payer: Galaxy Health WC |
$48,478.05
|
| Rate for Payer: Global Benefits Group Commercial |
$34,219.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,329.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,649.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,406.60
|
| Rate for Payer: Multiplan Commercial |
$42,774.75
|
| Rate for Payer: Networks By Design Commercial |
$37,071.45
|
| Rate for Payer: Prime Health Services Commercial |
$48,478.05
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
OP
|
$52,265.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$47,038.50 |
| Rate for Payer: Adventist Health Commercial |
$10,453.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,425.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28,745.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,198.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,687.00
|
| 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 |
$23,519.25
|
| Rate for Payer: Cash Price |
$23,519.25
|
| Rate for Payer: Cash Price |
$23,519.25
|
| Rate for Payer: Central Health Plan Commercial |
$41,812.00
|
| Rate for Payer: Cigna of CA HMO |
$33,449.60
|
| Rate for Payer: Cigna of CA PPO |
$38,676.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,425.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,425.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,425.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,585.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,906.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,906.00
|
| Rate for Payer: Galaxy Health WC |
$44,425.25
|
| Rate for Payer: Global Benefits Group Commercial |
$31,359.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$47,038.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,764.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,188.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,053.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,836.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,453.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,585.50
|
| Rate for Payer: Multiplan Commercial |
$39,198.75
|
| Rate for Payer: Networks By Design Commercial |
$33,972.25
|
| Rate for Payer: Prime Health Services Commercial |
$44,425.25
|
| Rate for Payer: Riverside University Health System MISP |
$20,906.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,359.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,132.50
|
| 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 |
$44,425.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,425.25
|
| Rate for Payer: Vantage Medical Group Senior |
$44,425.25
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
IP
|
$52,265.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,453.00 |
| Max. Negotiated Rate |
$47,038.50 |
| Rate for Payer: Adventist Health Commercial |
$10,453.00
|
| Rate for Payer: Cash Price |
$23,519.25
|
| Rate for Payer: Central Health Plan Commercial |
$41,812.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,585.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,906.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,906.00
|
| Rate for Payer: Galaxy Health WC |
$44,425.25
|
| Rate for Payer: Global Benefits Group Commercial |
$31,359.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$47,038.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,188.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,836.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,453.00
|
| Rate for Payer: Multiplan Commercial |
$39,198.75
|
| Rate for Payer: Networks By Design Commercial |
$33,972.25
|
| Rate for Payer: Prime Health Services Commercial |
$44,425.25
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$71.97 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.97
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$31.36
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
949000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$71.97 |
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.97
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$31.36
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
941000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$71.97 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.97
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$31.36
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.20
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
943100516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
949000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
942100516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
941000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
