|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.94
|
| Rate for Payer: Blue Shield of California Commercial |
$119.83
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Riverside University Health System MISP |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
|
|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
|
|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.94
|
| Rate for Payer: Blue Shield of California Commercial |
$119.83
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$120.96
|
| Rate for Payer: Cigna of CA PPO |
$139.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Riverside University Health System MISP |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
IP
|
$7,263.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,452.60 |
| Max. Negotiated Rate |
$6,536.70 |
| Rate for Payer: Adventist Health Commercial |
$1,452.60
|
| Rate for Payer: Cash Price |
$3,268.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,810.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,084.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,905.20
|
| Rate for Payer: Galaxy Health WC |
$6,173.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,357.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,536.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,612.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,285.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.60
|
| Rate for Payer: Multiplan Commercial |
$5,447.25
|
| Rate for Payer: Networks By Design Commercial |
$4,720.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,173.55
|
|
|
HC L&D LEVEL IV - 1ST HR
|
Facility
|
OP
|
$7,263.00
|
|
| Hospital Charge Code |
902400056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,452.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,452.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,173.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,994.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,447.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,516.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,224.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,268.35
|
| Rate for Payer: Cash Price |
$3,268.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,810.40
|
| Rate for Payer: Cigna of CA HMO |
$4,648.32
|
| Rate for Payer: Cigna of CA PPO |
$5,374.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,173.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,173.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,173.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,084.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,905.20
|
| Rate for Payer: Galaxy Health WC |
$6,173.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,357.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,536.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,612.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,636.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,285.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,084.10
|
| Rate for Payer: Multiplan Commercial |
$5,447.25
|
| Rate for Payer: Networks By Design Commercial |
$4,720.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,173.55
|
| Rate for Payer: Riverside University Health System MISP |
$2,905.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,357.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,631.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,173.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,173.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,173.55
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
OP
|
$391.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.44
|
| Rate for Payer: Blue Shield of California Commercial |
$247.89
|
| Rate for Payer: Blue Shield of California EPN |
$156.01
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$332.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$248.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$273.70
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Riverside University Health System MISP |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC L&D TREATMENT ROOM
|
Facility
|
IP
|
$391.00
|
|
| Hospital Charge Code |
902400418
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$248.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
OP
|
$44,282.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.91 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$8,856.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,443.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,443.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Central Health Plan Commercial |
$35,425.60
|
| Rate for Payer: Cigna of CA HMO |
$28,340.48
|
| Rate for Payer: Cigna of CA PPO |
$32,768.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,787.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,443.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30,997.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,180.97
|
| Rate for Payer: EPIC Health Plan Senior |
$14,787.31
|
| Rate for Payer: Galaxy Health WC |
$37,639.70
|
| Rate for Payer: Global Benefits Group Commercial |
$26,569.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,853.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,046.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$480.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,443.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,119.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$531.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,820.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,856.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,013.63
|
| Rate for Payer: Multiplan Commercial |
$33,211.50
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$28,783.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,443.01
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$37,639.70
|
| Rate for Payer: Prime Health Services Medicare |
$14,249.59
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,787.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,569.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,141.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,443.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13,443.01
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
IP
|
$44,282.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,856.40 |
| Max. Negotiated Rate |
$39,853.80 |
| Rate for Payer: Adventist Health Commercial |
$8,856.40
|
| Rate for Payer: Cash Price |
$19,926.90
|
| Rate for Payer: Central Health Plan Commercial |
$35,425.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30,997.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,712.80
|
| Rate for Payer: EPIC Health Plan Senior |
$17,712.80
|
| Rate for Payer: Galaxy Health WC |
$37,639.70
|
| Rate for Payer: Global Benefits Group Commercial |
$26,569.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,853.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,119.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,126.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,856.40
|
| Rate for Payer: Multiplan Commercial |
$33,211.50
|
| Rate for Payer: Networks By Design Commercial |
$28,783.30
|
| Rate for Payer: Prime Health Services Commercial |
$37,639.70
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
OP
|
$39,913.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$444.41 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$7,982.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,926.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,952.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,934.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$17,960.85
|
| Rate for Payer: Cash Price |
$17,960.85
|
| Rate for Payer: Cash Price |
$17,960.85
|
| Rate for Payer: Central Health Plan Commercial |
$31,930.40
|
| Rate for Payer: Cigna of CA HMO |
$25,544.32
|
| Rate for Payer: Cigna of CA PPO |
$29,535.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,926.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,926.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33,926.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,939.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,965.20
|
| Rate for Payer: Galaxy Health WC |
$33,926.05
|
| Rate for Payer: Global Benefits Group Commercial |
$23,947.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,921.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,344.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,548.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,982.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,939.10
|
| Rate for Payer: Multiplan Commercial |
$29,934.75
|
| Rate for Payer: Networks By Design Commercial |
$25,943.45
|
| Rate for Payer: Prime Health Services Commercial |
$33,926.05
|
| Rate for Payer: Riverside University Health System MISP |
$15,965.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,947.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,956.50
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,926.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,926.05
|
| Rate for Payer: Vantage Medical Group Senior |
$33,926.05
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
IP
|
$39,913.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,982.60 |
| Max. Negotiated Rate |
$35,921.70 |
| Rate for Payer: Adventist Health Commercial |
$7,982.60
|
| Rate for Payer: Cash Price |
$17,960.85
|
| Rate for Payer: Central Health Plan Commercial |
$31,930.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27,939.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15,965.20
|
| Rate for Payer: Galaxy Health WC |
$33,926.05
|
| Rate for Payer: Global Benefits Group Commercial |
$23,947.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$35,921.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,344.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,548.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,982.60
|
| Rate for Payer: Multiplan Commercial |
$29,934.75
|
| Rate for Payer: Networks By Design Commercial |
$25,943.45
|
| Rate for Payer: Prime Health Services Commercial |
$33,926.05
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
IP
|
$13,511.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,702.20 |
| Max. Negotiated Rate |
$12,159.90 |
| Rate for Payer: Adventist Health Commercial |
$2,702.20
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,808.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,457.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,404.40
|
| Rate for Payer: Galaxy Health WC |
$11,484.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,106.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,159.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,971.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.20
|
| Rate for Payer: Multiplan Commercial |
$10,133.25
|
| Rate for Payer: Networks By Design Commercial |
$8,782.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,484.35
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
OP
|
$13,511.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.22 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,702.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,643.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,632.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,808.80
|
| Rate for Payer: Cigna of CA HMO |
$8,647.04
|
| Rate for Payer: Cigna of CA PPO |
$9,998.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,457.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| Rate for Payer: Galaxy Health WC |
$11,484.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,106.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,159.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$10,133.25
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$8,782.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$11,484.35
|
| Rate for Payer: Prime Health Services Medicare |
$11,282.14
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,707.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,106.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,755.50
|
| 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 |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
IP
|
$13,511.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,702.20 |
| Max. Negotiated Rate |
$12,159.90 |
| Rate for Payer: Adventist Health Commercial |
$2,702.20
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,808.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,457.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,404.40
|
| Rate for Payer: Galaxy Health WC |
$11,484.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,106.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,159.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,971.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.20
|
| Rate for Payer: Multiplan Commercial |
$10,133.25
|
| Rate for Payer: Networks By Design Commercial |
$8,782.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,484.35
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
OP
|
$13,511.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.43 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,702.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$10,643.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,632.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,754.51
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Cash Price |
$6,079.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,808.80
|
| Rate for Payer: Cigna of CA HMO |
$8,647.04
|
| Rate for Payer: Cigna of CA PPO |
$9,998.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,457.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,561.82
|
| Rate for Payer: EPIC Health Plan Senior |
$11,707.88
|
| Rate for Payer: Galaxy Health WC |
$11,484.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,106.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,159.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17,455.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$768.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,579.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,900.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$10,133.25
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: Networks By Design Commercial |
$8,782.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Preferred Health Network WC |
$17,096.44
|
| Rate for Payer: Prime Health Services Commercial |
$11,484.35
|
| Rate for Payer: Prime Health Services Medicare |
$11,282.14
|
| Rate for Payer: Prime Health Services WC |
$16,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,707.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,106.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,755.50
|
| 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 |
$10,643.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
IP
|
$10,690.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,138.00 |
| Max. Negotiated Rate |
$9,621.00 |
| Rate for Payer: Adventist Health Commercial |
$2,138.00
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,552.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,276.00
|
| Rate for Payer: Galaxy Health WC |
$9,086.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,621.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,788.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,307.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,138.00
|
| Rate for Payer: Multiplan Commercial |
$8,017.50
|
| Rate for Payer: Networks By Design Commercial |
$6,948.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,086.50
|
|
|
HC LEAD REPAIR DUAL A & V
|
Facility
|
OP
|
$10,690.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
906811361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$507.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,138.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,806.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,552.00
|
| Rate for Payer: Cigna of CA HMO |
$6,841.60
|
| Rate for Payer: Cigna of CA PPO |
$7,910.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$9,086.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,621.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$507.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,788.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$8,017.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$6,948.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$9,086.50
|
| Rate for Payer: Prime Health Services Medicare |
$5,094.73
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,286.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
IP
|
$10,690.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,138.00 |
| Max. Negotiated Rate |
$9,621.00 |
| Rate for Payer: Adventist Health Commercial |
$2,138.00
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,552.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,276.00
|
| Rate for Payer: Galaxy Health WC |
$9,086.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,621.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,788.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,307.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,138.00
|
| Rate for Payer: Multiplan Commercial |
$8,017.50
|
| Rate for Payer: Networks By Design Commercial |
$6,948.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,086.50
|
|
|
HC LEAD REPAIR SINGLE A OR V
|
Facility
|
OP
|
$10,690.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
906811355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,138.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,806.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,367.67
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Cash Price |
$4,810.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,552.00
|
| Rate for Payer: Cigna of CA HMO |
$6,841.60
|
| Rate for Payer: Cigna of CA PPO |
$7,910.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,286.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,806.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,483.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,930.48
|
| Rate for Payer: EPIC Health Plan Senior |
$5,286.98
|
| Rate for Payer: Galaxy Health WC |
$9,086.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,621.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,882.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,788.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,728.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,440.51
|
| Rate for Payer: Multiplan Commercial |
$8,017.50
|
| Rate for Payer: Multiplan WC |
$7,367.67
|
| Rate for Payer: Networks By Design Commercial |
$6,948.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,806.35
|
| Rate for Payer: Preferred Health Network WC |
$7,518.03
|
| Rate for Payer: Prime Health Services Commercial |
$9,086.50
|
| Rate for Payer: Prime Health Services Medicare |
$5,094.73
|
| Rate for Payer: Prime Health Services WC |
$7,292.49
|
| Rate for Payer: Riverside University Health System MISP |
$5,286.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,209.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,286.98
|
| Rate for Payer: Vantage Medical Group Senior |
$4,806.35
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
OP
|
$4,219.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$843.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$1,898.55
|
| Rate for Payer: Cash Price |
$1,898.55
|
| Rate for Payer: Cash Price |
$1,898.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,375.20
|
| Rate for Payer: Cigna of CA HMO |
$2,700.16
|
| Rate for Payer: Cigna of CA PPO |
$3,122.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,953.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$3,586.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,531.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,797.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,679.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$3,164.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$2,742.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,586.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,531.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,109.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
IP
|
$4,219.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$843.80 |
| Max. Negotiated Rate |
$3,797.10 |
| Rate for Payer: Adventist Health Commercial |
$843.80
|
| Rate for Payer: Cash Price |
$1,898.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,375.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,953.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,687.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,687.60
|
| Rate for Payer: Galaxy Health WC |
$3,586.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,531.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,797.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,679.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,489.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.80
|
| Rate for Payer: Multiplan Commercial |
$3,164.25
|
| Rate for Payer: Networks By Design Commercial |
$2,742.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,586.15
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
IP
|
$4,441.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$888.20 |
| Max. Negotiated Rate |
$3,996.90 |
| Rate for Payer: Adventist Health Commercial |
$888.20
|
| Rate for Payer: Cash Price |
$1,998.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,552.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,108.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,776.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,776.40
|
| Rate for Payer: Galaxy Health WC |
$3,774.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,664.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,996.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,820.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,620.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.20
|
| Rate for Payer: Multiplan Commercial |
$3,330.75
|
| Rate for Payer: Networks By Design Commercial |
$2,886.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,774.85
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
OP
|
$4,441.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$888.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,998.45
|
| Rate for Payer: Cash Price |
$1,998.45
|
| Rate for Payer: Cash Price |
$1,998.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,552.80
|
| Rate for Payer: Cigna of CA HMO |
$2,842.24
|
| Rate for Payer: Cigna of CA PPO |
$3,286.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,108.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$3,774.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,664.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,996.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$462.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,820.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$510.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$3,330.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$2,886.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,774.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,664.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
