|
HC IRC-RN CASE MGMT VISIT (15MIN)
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
903400895
|
|
Hospital Revenue Code
|
551
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Blue Shield of California Commercial |
$14.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.58
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC IRIDOTOMY/IRIDECTOMY BY LASER
|
Facility
|
OP
|
$2,142.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
950510060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$428.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,110.63
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,713.60
|
| Rate for Payer: Cigna of CA HMO |
$1,370.88
|
| Rate for Payer: Cigna of CA PPO |
$1,585.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$941.02
|
| Rate for Payer: EPIC Health Plan Senior |
$697.05
|
| Rate for Payer: Galaxy Health WC |
$1,820.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,927.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,143.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$697.05
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,428.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$697.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$934.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$934.05
|
| Rate for Payer: Multiplan Commercial |
$1,606.50
|
| Rate for Payer: Multiplan WC |
$1,110.63
|
| Rate for Payer: Networks By Design Commercial |
$1,392.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$697.05
|
| Rate for Payer: Preferred Health Network WC |
$1,133.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,820.70
|
| Rate for Payer: Prime Health Services Medicare |
$738.87
|
| Rate for Payer: Prime Health Services WC |
$1,099.30
|
| Rate for Payer: Riverside University Health System MISP |
$766.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,071.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,071.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$697.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.75
|
| Rate for Payer: Vantage Medical Group Senior |
$697.05
|
|
|
HC IRIDOTOMY/IRIDECTOMY BY LASER
|
Facility
|
IP
|
$2,142.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
950510060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,927.80 |
| Rate for Payer: Adventist Health Commercial |
$428.40
|
| Rate for Payer: Cash Price |
$963.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,713.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$856.80
|
| Rate for Payer: EPIC Health Plan Senior |
$856.80
|
| Rate for Payer: Galaxy Health WC |
$1,820.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,927.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,428.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,325.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| Rate for Payer: Multiplan Commercial |
$1,606.50
|
| Rate for Payer: Networks By Design Commercial |
$1,392.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,820.70
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
900910437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.80
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
OP
|
$56.63
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
900910437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$50.97 |
| Rate for Payer: Adventist Health Commercial |
$11.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.10
|
| Rate for Payer: Blue Shield of California Commercial |
$34.37
|
| Rate for Payer: Blue Shield of California EPN |
$22.48
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Central Health Plan Commercial |
$45.30
|
| Rate for Payer: Cigna of CA HMO |
$36.24
|
| Rate for Payer: Cigna of CA PPO |
$41.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.74
|
| Rate for Payer: Galaxy Health WC |
$48.14
|
| Rate for Payer: Global Benefits Group Commercial |
$33.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.74
|
| Rate for Payer: InnovAge PACE Commercial |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$42.47
|
| Rate for Payer: Networks By Design Commercial |
$36.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$48.14
|
| Rate for Payer: Prime Health Services Medicare |
$9.26
|
| Rate for Payer: Riverside University Health System MISP |
$9.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.08
|
| Rate for Payer: United Healthcare All Other HMO |
$7.08
|
| Rate for Payer: United Healthcare HMO Rider |
$7.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Vantage Medical Group Senior |
$8.74
|
|
|
HC IRON TOTAL
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$47.12 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.56
|
| Rate for Payer: Blue Shield of California Commercial |
$26.71
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC IRON TOTAL
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.04
|
| 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 |
$135.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.44
|
| Rate for Payer: Blue Shield of California Commercial |
$171.08
|
| Rate for Payer: Blue Shield of California EPN |
$111.72
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| 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 |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.28
|
| 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 |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| 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 |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| 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 |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| 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 IRRIGATION CORPORA CAVERNOSA
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$181.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Central Health Plan Commercial |
$725.60
|
| Rate for Payer: Cigna of CA HMO |
$580.48
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$816.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$309.02
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Prime Health Services Medicare |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$453.50
|
| Rate for Payer: United Healthcare All Other HMO |
$453.50
|
| Rate for Payer: United Healthcare HMO Rider |
$453.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$453.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$816.30 |
| Rate for Payer: Adventist Health Commercial |
$181.40
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Central Health Plan Commercial |
$725.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: EPIC Health Plan Senior |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$816.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$561.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.40
|
| Rate for Payer: Multiplan Commercial |
$680.25
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
OP
|
$3,014.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$602.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,411.20
|
| Rate for Payer: Cigna of CA HMO |
$1,928.96
|
| Rate for Payer: Cigna of CA PPO |
$2,230.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$2,561.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,808.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,712.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,010.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$2,260.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,959.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$2,561.90
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,808.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,507.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,507.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,507.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
IP
|
$3,014.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$2,712.60 |
| Rate for Payer: Adventist Health Commercial |
$602.80
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,205.60
|
| Rate for Payer: Galaxy Health WC |
$2,561.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,808.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,712.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,010.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,148.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,865.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.80
|
| Rate for Payer: Multiplan Commercial |
$2,260.50
|
| Rate for Payer: Networks By Design Commercial |
$1,959.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,561.90
|
|
|
HC IRR OF IMPLA VAD FOR DRUG DELIV
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
910100138
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$230.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.59
|
| Rate for Payer: Blue Shield of California Commercial |
$231.57
|
| Rate for Payer: Blue Shield of California EPN |
$151.22
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPLA VAD FOR DRUG DELIV
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
910100138
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$230.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.59
|
| Rate for Payer: Blue Shield of California Commercial |
$231.57
|
| Rate for Payer: Blue Shield of California EPN |
$151.22
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$341.10 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$230.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.59
|
| Rate for Payer: Blue Shield of California Commercial |
$231.57
|
| Rate for Payer: Blue Shield of California EPN |
$151.22
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$230.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.59
|
| Rate for Payer: Blue Shield of California Commercial |
$231.57
|
| Rate for Payer: Blue Shield of California EPN |
$151.22
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$230.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.59
|
| Rate for Payer: Blue Shield of California Commercial |
$231.57
|
| Rate for Payer: Blue Shield of California EPN |
$151.22
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Central Health Plan Commercial |
$303.20
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$341.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$284.25
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
915352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$658.80 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$565.84
|
| Rate for Payer: Blue Shield of California EPN |
$368.93
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Central Health Plan Commercial |
$585.60
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$658.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
905352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$658.80 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$565.84
|
| Rate for Payer: Blue Shield of California EPN |
$368.93
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Central Health Plan Commercial |
$585.60
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$658.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
| Rate for Payer: Networks By Design Commercial |
$475.80
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
|
