|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.98
|
| Rate for Payer: Blue Shield of California Commercial |
$118.97
|
| Rate for Payer: Blue Shield of California EPN |
$77.81
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.16
|
| Rate for Payer: EPIC Health Plan Senior |
$22.34
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: InnovAge PACE Commercial |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.34
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Medicare |
$23.68
|
| Rate for Payer: Riverside University Health System MISP |
$24.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.10
|
| Rate for Payer: United Healthcare All Other HMO |
$18.10
|
| Rate for Payer: United Healthcare HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$240.73
|
| Rate for Payer: Blue Shield of California EPN |
$157.21
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Central Health Plan Commercial |
$315.20
|
| Rate for Payer: Cigna of CA HMO |
$252.16
|
| Rate for Payer: Cigna of CA PPO |
$291.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$334.90
|
| Rate for Payer: Global Benefits Group Commercial |
$236.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$295.50
|
| Rate for Payer: Networks By Design Commercial |
$256.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$334.90
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.00
|
| Rate for Payer: United Healthcare All Other HMO |
$197.00
|
| Rate for Payer: United Healthcare HMO Rider |
$197.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Central Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.90
|
| Rate for Payer: Global Benefits Group Commercial |
$236.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Multiplan Commercial |
$295.50
|
| Rate for Payer: Networks By Design Commercial |
$256.10
|
| Rate for Payer: Prime Health Services Commercial |
$334.90
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$161.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$79.47
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Central Health Plan Commercial |
$315.20
|
| Rate for Payer: Cigna of CA HMO |
$252.16
|
| Rate for Payer: Cigna of CA PPO |
$291.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$334.90
|
| Rate for Payer: Global Benefits Group Commercial |
$236.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$295.50
|
| Rate for Payer: Multiplan WC |
$79.47
|
| Rate for Payer: Networks By Design Commercial |
$256.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.87
|
| Rate for Payer: Preferred Health Network WC |
$81.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.90
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Prime Health Services WC |
$78.66
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$354.60 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Cash Price |
$216.70
|
| Rate for Payer: Central Health Plan Commercial |
$315.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.90
|
| Rate for Payer: Global Benefits Group Commercial |
$236.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.80
|
| Rate for Payer: Multiplan Commercial |
$295.50
|
| Rate for Payer: Networks By Design Commercial |
$256.10
|
| Rate for Payer: Prime Health Services Commercial |
$334.90
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
OP
|
$12,136.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.46 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,674.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,102.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,227.69
|
| Rate for Payer: Blue Shield of California EPN |
$6,020.76
|
| Rate for Payer: Cash Price |
$6,674.80
|
| Rate for Payer: Cash Price |
$6,674.80
|
| Rate for Payer: Cash Price |
$6,674.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,708.80
|
| Rate for Payer: Cigna of CA HMO |
$7,767.04
|
| Rate for Payer: Cigna of CA PPO |
$8,980.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,315.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,315.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,854.40
|
| Rate for Payer: Galaxy Health WC |
$10,315.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,281.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,922.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.46
|
| Rate for Payer: InnovAge PACE Commercial |
$6,068.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,094.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,512.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,427.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,495.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,495.20
|
| Rate for Payer: Multiplan Commercial |
$9,102.00
|
| Rate for Payer: Networks By Design Commercial |
$7,888.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,315.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,854.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,281.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,315.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,315.60
|
| Rate for Payer: Vantage Medical Group Senior |
$10,315.60
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
IP
|
$12,136.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,427.20 |
| Max. Negotiated Rate |
$10,922.40 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| Rate for Payer: Cash Price |
$6,674.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,708.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,854.40
|
| Rate for Payer: Galaxy Health WC |
$10,315.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,281.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,922.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,094.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,623.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,512.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,427.20
|
| Rate for Payer: Multiplan Commercial |
$9,102.00
|
| Rate for Payer: Networks By Design Commercial |
$7,888.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,315.60
|
|
|
HC IMPL AGA DUCT OCCLUDER II
|
Facility
|
OP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$10,267.20 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,274.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,556.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,208.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,316.61
|
| Rate for Payer: Blue Shield of California Commercial |
$8,818.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,749.63
|
| Rate for Payer: Cash Price |
$6,274.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,126.40
|
| Rate for Payer: Cigna of CA HMO |
$7,985.60
|
| Rate for Payer: Cigna of CA PPO |
$7,985.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,696.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,563.20
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,267.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,704.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,346.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,061.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,281.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,985.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,985.60
|
| Rate for Payer: Multiplan Commercial |
$8,556.00
|
| Rate for Payer: Networks By Design Commercial |
$5,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,563.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,844.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,844.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,281.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4,167.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4,077.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,736.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,696.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,696.80
|
|
|
HC IMPL AGA DUCT OCCLUDER II
|
Facility
|
IP
|
$11,408.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,281.60 |
| Max. Negotiated Rate |
$10,267.20 |
| Rate for Payer: Adventist Health Commercial |
$2,281.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,818.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,749.63
|
| Rate for Payer: Cash Price |
$6,274.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,126.40
|
| Rate for Payer: Cigna of CA HMO |
$7,985.60
|
| Rate for Payer: Cigna of CA PPO |
$7,985.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,563.20
|
| Rate for Payer: Galaxy Health WC |
$9,696.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,844.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,267.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,609.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,346.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,061.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,281.60
|
| Rate for Payer: Multiplan Commercial |
$8,556.00
|
| Rate for Payer: Networks By Design Commercial |
$5,704.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,696.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,281.42
|
| Rate for Payer: United Healthcare All Other HMO |
$4,167.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4,077.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,736.12
|
|
|
HC IMPL AGA VAS PLUG II OCCL
|
Facility
|
OP
|
$3,244.80
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.96 |
| Max. Negotiated Rate |
$2,920.32 |
| Rate for Payer: Adventist Health Commercial |
$648.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,784.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,433.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,796.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,508.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,635.38
|
| Rate for Payer: Cash Price |
$1,784.64
|
| Rate for Payer: Central Health Plan Commercial |
$2,595.84
|
| Rate for Payer: Cigna of CA HMO |
$2,271.36
|
| Rate for Payer: Cigna of CA PPO |
$2,271.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,758.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,758.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,297.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1,297.92
|
| Rate for Payer: Galaxy Health WC |
$2,758.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1,946.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,920.32
|
| Rate for Payer: InnovAge PACE Commercial |
$1,622.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,164.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$648.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,271.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,271.36
|
| Rate for Payer: Multiplan Commercial |
$2,433.60
|
| Rate for Payer: Networks By Design Commercial |
$1,622.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,758.08
|
| Rate for Payer: Riverside University Health System MISP |
$1,297.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,946.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,946.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,185.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,159.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,758.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,758.08
|
| Rate for Payer: Vantage Medical Group Senior |
$2,758.08
|
|
|
HC IMPL AGA VAS PLUG II OCCL
|
Facility
|
IP
|
$3,244.80
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.96 |
| Max. Negotiated Rate |
$2,920.32 |
| Rate for Payer: Adventist Health Commercial |
$648.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2,508.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,635.38
|
| Rate for Payer: Cash Price |
$1,784.64
|
| Rate for Payer: Central Health Plan Commercial |
$2,595.84
|
| Rate for Payer: Cigna of CA HMO |
$2,271.36
|
| Rate for Payer: Cigna of CA PPO |
$2,271.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,297.92
|
| Rate for Payer: EPIC Health Plan Senior |
$1,297.92
|
| Rate for Payer: Galaxy Health WC |
$2,758.08
|
| Rate for Payer: Global Benefits Group Commercial |
$1,946.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,920.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,164.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$648.96
|
| Rate for Payer: Multiplan Commercial |
$2,433.60
|
| Rate for Payer: Networks By Design Commercial |
$1,622.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,758.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,185.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,159.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.67
|
|
|
HC IMPL AGA VSD OCCL DEVICE
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,849.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,305.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$8,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$7,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.00
|
|
|
HC IMPL AGA VSD OCCL DEVICE
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$8,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$7,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$896.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.26
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: InnovAge PACE Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Riverside University Health System MISP |
$648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.26
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
|
OP
|
$2,172.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,954.80 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,194.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,629.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$991.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,202.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,678.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,094.69
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,737.60
|
| Rate for Payer: Cigna of CA HMO |
$1,520.40
|
| Rate for Payer: Cigna of CA PPO |
$1,520.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,846.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,846.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,954.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,086.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,344.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,520.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,520.40
|
| Rate for Payer: Multiplan Commercial |
$1,629.00
|
| Rate for Payer: Networks By Design Commercial |
$1,086.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: Riverside University Health System MISP |
$868.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,303.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,303.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other HMO |
$793.43
|
| Rate for Payer: United Healthcare HMO Rider |
$776.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,846.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,846.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,846.20
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
|
IP
|
$2,172.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,954.80 |
| Rate for Payer: Adventist Health Commercial |
$434.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,678.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,094.69
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,737.60
|
| Rate for Payer: Cigna of CA HMO |
$1,520.40
|
| Rate for Payer: Cigna of CA PPO |
$1,520.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$868.80
|
| Rate for Payer: Galaxy Health WC |
$1,846.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,303.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,954.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,344.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.40
|
| Rate for Payer: Multiplan Commercial |
$1,629.00
|
| Rate for Payer: Networks By Design Commercial |
$1,086.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,846.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other HMO |
$793.43
|
| Rate for Payer: United Healthcare HMO Rider |
$776.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.33
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
IP
|
$28,856.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,771.20 |
| Max. Negotiated Rate |
$25,970.40 |
| Rate for Payer: Adventist Health Commercial |
$5,771.20
|
| Rate for Payer: Cash Price |
$15,870.80
|
| Rate for Payer: Central Health Plan Commercial |
$23,084.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,542.40
|
| Rate for Payer: EPIC Health Plan Senior |
$11,542.40
|
| Rate for Payer: Galaxy Health WC |
$24,527.60
|
| Rate for Payer: Global Benefits Group Commercial |
$17,313.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,970.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,246.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,994.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,861.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,771.20
|
| Rate for Payer: Multiplan Commercial |
$21,642.00
|
| Rate for Payer: Networks By Design Commercial |
$18,756.40
|
| Rate for Payer: Prime Health Services Commercial |
$24,527.60
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
OP
|
$28,856.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$365.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$5,771.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$15,870.80
|
| Rate for Payer: Cash Price |
$15,870.80
|
| Rate for Payer: Cash Price |
$15,870.80
|
| Rate for Payer: Central Health Plan Commercial |
$23,084.80
|
| Rate for Payer: Cigna of CA HMO |
$18,467.84
|
| Rate for Payer: Cigna of CA PPO |
$21,353.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$24,527.60
|
| Rate for Payer: Global Benefits Group Commercial |
$17,313.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,970.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$365.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,246.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,771.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$21,642.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$18,756.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$24,527.60
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,313.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC IMPL AROA MATRIX 10CM W X 10CM L 1MM THK
|
Facility
|
OP
|
$4,501.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$4,050.90 |
| Rate for Payer: Adventist Health Commercial |
$900.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,733.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,825.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,475.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,375.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,179.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,643.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,750.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,795.90
|
| Rate for Payer: Cash Price |
$2,475.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,600.80
|
| Rate for Payer: Cigna of CA HMO |
$3,150.70
|
| Rate for Payer: Cigna of CA PPO |
$3,150.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,825.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,825.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,825.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.40
|
| Rate for Payer: Galaxy Health WC |
$3,825.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,050.90
|
| Rate for Payer: InnovAge PACE Commercial |
$2,250.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,150.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,150.70
|
| Rate for Payer: Multiplan Commercial |
$3,375.75
|
| Rate for Payer: Networks By Design Commercial |
$2,250.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,700.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,700.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,825.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.85
|
|
|
HC IMPL AROA MATRIX 10CM W X 10CM L 1MM THK
|
Facility
|
IP
|
$4,501.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$4,050.90 |
| Rate for Payer: Adventist Health Commercial |
$900.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,479.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.50
|
| Rate for Payer: Cash Price |
$2,475.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,600.80
|
| Rate for Payer: Cigna of CA HMO |
$3,150.70
|
| Rate for Payer: Cigna of CA PPO |
$3,150.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.40
|
| Rate for Payer: Galaxy Health WC |
$3,825.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,050.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,714.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.20
|
| Rate for Payer: Multiplan Commercial |
$3,375.75
|
| Rate for Payer: Networks By Design Commercial |
$2,250.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.08
|
|
|
HC IMPL AROA MATRIX 10CM W X 20CM L 1MM THK
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,713.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,769.04
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
|
|
HC IMPL AROA MATRIX 10CM W X 20CM L 1MM THK
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,131.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,699.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,144.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.49
|
| Rate for Payer: Cash Price |
$1,930.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,457.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC IMPL AROA MYRIAD 20CMX20CM
|
Facility
|
IP
|
$11,905.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,381.00 |
| Max. Negotiated Rate |
$10,714.50 |
| Rate for Payer: Adventist Health Commercial |
$2,381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,202.57
|
| Rate for Payer: Blue Shield of California EPN |
$6,000.12
|
| Rate for Payer: Cash Price |
$6,547.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,524.00
|
| Rate for Payer: Cigna of CA HMO |
$8,333.50
|
| Rate for Payer: Cigna of CA PPO |
$8,333.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,762.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,762.00
|
| Rate for Payer: Galaxy Health WC |
$10,119.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,143.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,714.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,940.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,535.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,369.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,381.00
|
| Rate for Payer: Multiplan Commercial |
$8,928.75
|
| Rate for Payer: Networks By Design Commercial |
$5,952.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,119.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,467.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,348.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,254.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,898.89
|
|
|
HC IMPL AROA MYRIAD 20CMX20CM
|
Facility
|
OP
|
$11,905.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,381.00 |
| Max. Negotiated Rate |
$10,714.50 |
| Rate for Payer: Adventist Health Commercial |
$2,381.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,229.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,119.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,547.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,928.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,764.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,991.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7,273.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,750.10
|
| Rate for Payer: Cash Price |
$6,547.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,524.00
|
| Rate for Payer: Cigna of CA HMO |
$8,333.50
|
| Rate for Payer: Cigna of CA PPO |
$8,333.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,119.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,119.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,762.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,762.00
|
| Rate for Payer: Galaxy Health WC |
$10,119.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,143.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,714.50
|
| Rate for Payer: InnovAge PACE Commercial |
$5,952.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,940.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,369.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,381.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,333.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,333.50
|
| Rate for Payer: Multiplan Commercial |
$8,928.75
|
| Rate for Payer: Networks By Design Commercial |
$5,952.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,119.25
|
| Rate for Payer: Riverside University Health System MISP |
$4,762.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,143.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,143.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,467.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,348.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,254.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,898.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,119.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,119.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10,119.25
|
|
