|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$170.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.89
|
| Rate for Payer: Blue Shield of California Commercial |
$196.54
|
| Rate for Payer: Blue Shield of California EPN |
$123.69
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$263.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$263.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$153.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$217.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Riverside University Health System MISP |
$124.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$263.50
|
| Rate for Payer: Vantage Medical Group Senior |
$263.50
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Blue Shield of California Commercial |
$248.62
|
| Rate for Payer: Blue Shield of California EPN |
$156.24
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$196.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
|
|
HC I-125 SEED
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.23
|
| Rate for Payer: Blue Shield of California Commercial |
$210.93
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$184.10
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Riverside University Health System MISP |
$105.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC I-125 SEED
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Blue Shield of California Commercial |
$210.93
|
| Rate for Payer: Blue Shield of California EPN |
$132.55
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Central Health Plan Commercial |
$210.40
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$155.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.60
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$773.95 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$469.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$515.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$469.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.69
|
| Rate for Payer: Blue Shield of California Commercial |
$277.69
|
| Rate for Payer: Blue Shield of California EPN |
$174.76
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$515.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$469.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.95
|
| Rate for Payer: EPIC Health Plan Senior |
$515.97
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$769.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$469.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$656.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$628.54
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$469.06
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Prime Health Services Medicare |
$497.20
|
| Rate for Payer: Riverside University Health System MISP |
$515.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$469.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$515.97
|
| Rate for Payer: Vantage Medical Group Senior |
$469.06
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$351.28
|
| Rate for Payer: Blue Shield of California EPN |
$220.75
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
OP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$792.85 |
| Max. Negotiated Rate |
$5,177.70 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$953.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$953.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$860.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,073.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,647.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,295.45
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,602.40
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$953.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,027.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.47
|
| Rate for Payer: EPIC Health Plan Senior |
$1,048.31
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,177.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,562.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$953.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,653.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$875.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,334.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,277.03
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$953.01
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,010.19
|
| Rate for Payer: Riverside University Health System MISP |
$1,048.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,451.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,451.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$953.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.31
|
| Rate for Payer: Vantage Medical Group Senior |
$953.01
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
IP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,150.60 |
| Max. Negotiated Rate |
$5,177.70 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,613.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,899.51
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,602.40
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,027.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,177.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,653.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,394.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,150.60
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Blue Shield of California Commercial |
$174.03
|
| Rate for Payer: Blue Shield of California EPN |
$109.37
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.85
|
| Rate for Payer: Blue Shield of California Commercial |
$136.71
|
| Rate for Payer: Blue Shield of California EPN |
$86.15
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.27
|
| Rate for Payer: EPIC Health Plan Senior |
$22.85
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.83
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.77
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Prime Health Services Medicare |
$22.02
|
| Rate for Payer: Riverside University Health System MISP |
$22.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.85
|
| Rate for Payer: Vantage Medical Group Senior |
$22.85
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
IP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$410.92 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: Central Health Plan Commercial |
$365.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.32
|
| Rate for Payer: Multiplan Commercial |
$342.44
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
|
|
HC IAP MONITORIN DEVICE
|
Facility
|
OP
|
$456.58
|
|
| Hospital Charge Code |
901698334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.32 |
| Max. Negotiated Rate |
$410.92 |
| Rate for Payer: Adventist Health Commercial |
$91.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.59
|
| Rate for Payer: Blue Shield of California Commercial |
$289.47
|
| Rate for Payer: Blue Shield of California EPN |
$182.18
|
| Rate for Payer: Cash Price |
$205.46
|
| Rate for Payer: Central Health Plan Commercial |
$365.26
|
| Rate for Payer: Cigna of CA HMO |
$292.21
|
| Rate for Payer: Cigna of CA PPO |
$337.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$388.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$388.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$388.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.63
|
| Rate for Payer: EPIC Health Plan Senior |
$182.63
|
| Rate for Payer: Galaxy Health WC |
$388.09
|
| Rate for Payer: Global Benefits Group Commercial |
$273.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$410.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$319.61
|
| Rate for Payer: Multiplan Commercial |
$342.44
|
| Rate for Payer: Networks By Design Commercial |
$296.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.09
|
| Rate for Payer: Riverside University Health System MISP |
$182.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.29
|
| Rate for Payer: United Healthcare All Other HMO |
$228.29
|
| Rate for Payer: United Healthcare HMO Rider |
$228.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$388.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$388.09
|
| Rate for Payer: Vantage Medical Group Senior |
$388.09
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
IP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$490.16 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: Central Health Plan Commercial |
$435.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$381.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$345.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$321.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.92
|
| Rate for Payer: Multiplan Commercial |
$408.46
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
|
|
HC IAP MONITORING DEVICE
|
Facility
|
OP
|
$544.62
|
|
| Hospital Charge Code |
901698404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$490.16 |
| Rate for Payer: Adventist Health Commercial |
$108.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$299.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$263.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.81
|
| Rate for Payer: Blue Shield of California Commercial |
$345.29
|
| Rate for Payer: Blue Shield of California EPN |
$217.30
|
| Rate for Payer: Cash Price |
$245.08
|
| Rate for Payer: Central Health Plan Commercial |
$435.70
|
| Rate for Payer: Cigna of CA HMO |
$348.56
|
| Rate for Payer: Cigna of CA PPO |
$403.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$462.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$462.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$381.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.85
|
| Rate for Payer: EPIC Health Plan Senior |
$217.85
|
| Rate for Payer: Galaxy Health WC |
$462.93
|
| Rate for Payer: Global Benefits Group Commercial |
$326.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$345.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$321.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$381.23
|
| Rate for Payer: Multiplan Commercial |
$408.46
|
| Rate for Payer: Networks By Design Commercial |
$354.00
|
| Rate for Payer: Prime Health Services Commercial |
$462.93
|
| Rate for Payer: Riverside University Health System MISP |
$217.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.31
|
| Rate for Payer: United Healthcare All Other HMO |
$272.31
|
| Rate for Payer: United Healthcare HMO Rider |
$272.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.93
|
| Rate for Payer: Vantage Medical Group Senior |
$462.93
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$10,022.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,004.40 |
| Max. Negotiated Rate |
$9,019.80 |
| Rate for Payer: Adventist Health Commercial |
$2,004.40
|
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,017.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,015.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,008.80
|
| Rate for Payer: Galaxy Health WC |
$8,518.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,019.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,363.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,912.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.40
|
| Rate for Payer: Multiplan Commercial |
$7,516.50
|
| Rate for Payer: Networks By Design Commercial |
$6,514.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,518.70
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$10,022.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,138.00 |
| Rate for Payer: Adventist Health Commercial |
$2,004.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,950.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,518.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,512.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| 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 |
$4,509.90
|
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Cash Price |
$4,509.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,017.60
|
| Rate for Payer: Cigna of CA HMO |
$6,414.08
|
| Rate for Payer: Cigna of CA PPO |
$7,416.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,518.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,518.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,518.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,015.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,008.80
|
| Rate for Payer: Galaxy Health WC |
$8,518.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,019.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$934.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,363.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,031.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,912.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,015.40
|
| Rate for Payer: Multiplan Commercial |
$7,516.50
|
| Rate for Payer: Networks By Design Commercial |
$6,514.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,518.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,008.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,013.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,013.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,518.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,518.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,518.70
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$4,556.70 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,544.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.20
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,215.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,987.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,012.60 |
| Max. Negotiated Rate |
$46,216.00 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,303.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,784.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,797.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,216.00
|
| 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 |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,050.40
|
| Rate for Payer: Cigna of CA HMO |
$3,240.32
|
| Rate for Payer: Cigna of CA PPO |
$3,746.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,303.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,303.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,303.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,544.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,025.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,025.20
|
| Rate for Payer: Galaxy Health WC |
$4,303.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,037.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,556.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,541.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,215.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,702.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,987.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,544.10
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Networks By Design Commercial |
$3,290.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,303.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,025.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,037.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,531.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,303.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,303.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,303.55
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$962.00 |
| Max. Negotiated Rate |
$4,329.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,367.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,924.00
|
| Rate for Payer: Galaxy Health WC |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,054.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,837.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,088.50
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.07 |
| Max. Negotiated Rate |
$46,216.00 |
| Rate for Payer: Adventist Health Commercial |
$962.00
|
| 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 |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Cash Price |
$2,164.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,848.00
|
| Rate for Payer: Cigna of CA HMO |
$3,078.40
|
| Rate for Payer: Cigna of CA PPO |
$3,559.40
|
| 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 |
$3,367.00
|
| 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 |
$4,088.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,886.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,329.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$258.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,054.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$3,607.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$3,126.50
|
| 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 |
$4,088.50
|
| 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 |
$2,886.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| 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 ICD INSERT EXIST DUAL LEADS
|
Facility
|
OP
|
$76,817.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906811425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.90 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Commercial |
$15,363.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$28,608.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,608.96
|
| 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 |
$45,441.74
|
| 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 |
$34,567.65
|
| Rate for Payer: Cash Price |
$34,567.65
|
| Rate for Payer: Cash Price |
$34,567.65
|
| Rate for Payer: Central Health Plan Commercial |
$61,453.60
|
| Rate for Payer: Cigna of CA HMO |
$49,162.88
|
| Rate for Payer: Cigna of CA PPO |
$56,844.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,469.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,608.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,204.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31,469.86
|
| Rate for Payer: Galaxy Health WC |
$65,294.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46,090.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69,135.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$46,918.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48,778.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,052.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,363.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,336.01
|
| Rate for Payer: Multiplan Commercial |
$57,612.75
|
| Rate for Payer: Multiplan WC |
$45,441.74
|
| Rate for Payer: Networks By Design Commercial |
$49,931.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Preferred Health Network WC |
$46,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$65,294.45
|
| Rate for Payer: Prime Health Services Medicare |
$30,325.50
|
| Rate for Payer: Prime Health Services WC |
$44,978.05
|
| Rate for Payer: Riverside University Health System MISP |
$31,469.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,090.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38,408.50
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$28,608.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28,608.96
|
|
|
HC ICD INSERT EXIST DUAL LEADS
|
Facility
|
IP
|
$76,817.00
|
|
|
Service Code
|
CPT 33230
|
| Hospital Charge Code |
906811425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,363.40 |
| Max. Negotiated Rate |
$69,135.30 |
| Rate for Payer: Adventist Health Commercial |
$15,363.40
|
| Rate for Payer: Cash Price |
$34,567.65
|
| Rate for Payer: Central Health Plan Commercial |
$61,453.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,726.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30,726.80
|
| Rate for Payer: Galaxy Health WC |
$65,294.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46,090.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69,135.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48,778.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,322.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,363.40
|
| Rate for Payer: Multiplan Commercial |
$57,612.75
|
| Rate for Payer: Networks By Design Commercial |
$49,931.05
|
| Rate for Payer: Prime Health Services Commercial |
$65,294.45
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
IP
|
$76,817.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906811426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,363.40 |
| Max. Negotiated Rate |
$69,135.30 |
| Rate for Payer: Adventist Health Commercial |
$15,363.40
|
| Rate for Payer: Cash Price |
$34,567.65
|
| Rate for Payer: Central Health Plan Commercial |
$61,453.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,726.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30,726.80
|
| Rate for Payer: Galaxy Health WC |
$65,294.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46,090.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69,135.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48,778.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,322.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,363.40
|
| Rate for Payer: Multiplan Commercial |
$57,612.75
|
| Rate for Payer: Networks By Design Commercial |
$49,931.05
|
| Rate for Payer: Prime Health Services Commercial |
$65,294.45
|
|
|
HC ICD INSERT EXIST MULT HC LEADS
|
Facility
|
OP
|
$76,817.00
|
|
|
Service Code
|
CPT 33231
|
| Hospital Charge Code |
906811426
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.40 |
| Max. Negotiated Rate |
$97,437.00 |
| Rate for Payer: Adventist Health Commercial |
$15,363.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$40,371.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| 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 |
$64,907.85
|
| 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 |
$34,567.65
|
| Rate for Payer: Cash Price |
$34,567.65
|
| Rate for Payer: Cash Price |
$34,567.65
|
| Rate for Payer: Central Health Plan Commercial |
$61,453.60
|
| Rate for Payer: Cigna of CA HMO |
$49,162.88
|
| Rate for Payer: Cigna of CA PPO |
$56,844.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,612.68
|
| Rate for Payer: EPIC Health Plan Senior |
$44,408.45
|
| Rate for Payer: Galaxy Health WC |
$65,294.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46,090.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69,135.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$66,208.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$558.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48,778.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$616.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,519.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,363.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$57,612.75
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: Networks By Design Commercial |
$49,931.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Preferred Health Network WC |
$66,232.50
|
| Rate for Payer: Prime Health Services Commercial |
$65,294.45
|
| Rate for Payer: Prime Health Services Medicare |
$42,793.60
|
| Rate for Payer: Prime Health Services WC |
$64,245.53
|
| Rate for Payer: Riverside University Health System MISP |
$44,408.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,090.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38,408.50
|
| Rate for Payer: United Healthcare All Other HMO |
$97,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84,191.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77,134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$40,371.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
|
HC ICD INSERT/REPL + DUAL LEADS
|
Facility
|
IP
|
$78,687.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
906811378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,737.40 |
| Max. Negotiated Rate |
$70,818.30 |
| Rate for Payer: Adventist Health Commercial |
$15,737.40
|
| Rate for Payer: Cash Price |
$35,409.15
|
| Rate for Payer: Central Health Plan Commercial |
$62,949.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55,080.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$31,474.80
|
| Rate for Payer: Galaxy Health WC |
$66,883.95
|
| Rate for Payer: Global Benefits Group Commercial |
$47,212.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$70,818.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49,966.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,425.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,737.40
|
| Rate for Payer: Multiplan Commercial |
$59,015.25
|
| Rate for Payer: Networks By Design Commercial |
$51,146.55
|
| Rate for Payer: Prime Health Services Commercial |
$66,883.95
|
|
