|
HC IRIDOTOMY/IRIDECTOMY BY LASER
|
Facility
|
OP
|
$1,730.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
950510060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$1,089.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$726.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,038.00
|
| Rate for Payer: Caremore Medicare Advantage |
$726.26
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,384.00
|
| Rate for Payer: Cigna of CA PPO |
$1,280.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Dignity Health Media |
$726.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$726.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$726.26
|
| Rate for Payer: Galaxy Health WC |
$1,470.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,557.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,297.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,191.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$726.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,089.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,153.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.19
|
| Rate for Payer: Multiplan Commercial |
$1,297.50
|
| Rate for Payer: Networks By Design Commercial |
$1,124.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,470.50
|
| Rate for Payer: Prime Health Services Medicare |
$769.84
|
| Rate for Payer: Riverside University Health System MISP |
$798.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,038.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$865.00
|
| Rate for Payer: United Healthcare All Other HMO |
$865.00
|
| Rate for Payer: United Healthcare HMO Rider |
$865.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$865.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Vantage Medical Group Senior |
$726.26
|
|
|
HC IRON BINDING CAPACITY
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
900910437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$60.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.36
|
| 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 |
$60.70
|
| Rate for Payer: Blue Distinction Transplant |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Caremore Medicare Advantage |
$8.74
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.11
|
| Rate for Payer: Dignity Health Media |
$8.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.74
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.42
|
| 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 |
$22.68
|
| 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 |
$6.80
|
| 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 |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| 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 |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| 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: 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 BINDING CAPACITY
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
900910437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC IRON TOTAL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC IRON TOTAL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900910243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$57.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| 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 |
$57.47
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Media |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| 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 |
$4.00
|
| 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 |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| 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 |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Central Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.60
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
|
|
HC IRRADIATION PROCEDURE
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904409
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.65
|
| Rate for Payer: Blue Distinction Transplant |
$179.40
|
| Rate for Payer: Blue Shield of California Commercial |
$188.07
|
| Rate for Payer: Blue Shield of California EPN |
$146.21
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Central Health Plan Commercial |
$239.20
|
| Rate for Payer: Cigna of CA HMO |
$191.36
|
| Rate for Payer: Cigna of CA PPO |
$221.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$254.15
|
| Rate for Payer: Global Benefits Group Commercial |
$179.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$224.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$224.25
|
| Rate for Payer: Networks By Design Commercial |
$194.35
|
| Rate for Payer: Prime Health Services Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$179.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$179.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$498.00
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$622.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$415.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC IRRIGATION CORPORA CAVERNOSA
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
900501294
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
OP
|
$2,279.00
|
|
|
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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,367.40
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.20
|
| Rate for Payer: Cigna of CA PPO |
$1,686.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,051.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,709.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$1,709.25
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,367.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,139.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,139.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,139.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,139.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC IRRIGATION, MAXILLARY SINUS
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
900501538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.80 |
| Max. Negotiated Rate |
$2,051.10 |
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.60
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,051.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.80
|
| Rate for Payer: Multiplan Commercial |
$1,709.25
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
|
|
HC IRR OF IMPLA VAD FOR DRUG DELIV
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
910100138
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.86
|
| Rate for Payer: Blue Distinction Transplant |
$256.80
|
| Rate for Payer: Blue Shield of California Commercial |
$269.21
|
| Rate for Payer: Blue Shield of California EPN |
$209.29
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: Cigna of CA HMO |
$273.92
|
| Rate for Payer: Cigna of CA PPO |
$316.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$321.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC IRR OF IMPLA VAD FOR DRUG DELIV
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
910100138
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.20
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.86
|
| Rate for Payer: Blue Distinction Transplant |
$256.80
|
| Rate for Payer: Blue Shield of California Commercial |
$269.21
|
| Rate for Payer: Blue Shield of California EPN |
$209.29
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: Cigna of CA HMO |
$273.92
|
| Rate for Payer: Cigna of CA PPO |
$316.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$321.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.20
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.20
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
911800106
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.86
|
| Rate for Payer: Blue Distinction Transplant |
$256.80
|
| Rate for Payer: Blue Shield of California Commercial |
$269.21
|
| Rate for Payer: Blue Shield of California EPN |
$209.29
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: Cigna of CA HMO |
$273.92
|
| Rate for Payer: Cigna of CA PPO |
$316.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$321.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.20
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100954
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.20
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100952
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.86
|
| Rate for Payer: Blue Distinction Transplant |
$256.80
|
| Rate for Payer: Blue Shield of California Commercial |
$269.21
|
| Rate for Payer: Blue Shield of California EPN |
$209.29
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: Cigna of CA HMO |
$273.92
|
| Rate for Payer: Cigna of CA PPO |
$316.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$321.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC IRR OF IMPL VAD FOR DRUG DELIV
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
900100953
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.86
|
| Rate for Payer: Blue Distinction Transplant |
$256.80
|
| Rate for Payer: Blue Shield of California Commercial |
$269.21
|
| Rate for Payer: Blue Shield of California EPN |
$209.29
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Central Health Plan Commercial |
$342.40
|
| Rate for Payer: Cigna of CA HMO |
$273.92
|
| Rate for Payer: Cigna of CA PPO |
$316.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$363.80
|
| Rate for Payer: Global Benefits Group Commercial |
$256.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$385.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$321.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$285.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Networks By Design Commercial |
$278.20
|
| Rate for Payer: Prime Health Services Commercial |
$363.80
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
905352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$658.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$402.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$354.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.47
|
| Rate for Payer: Blue Distinction Transplant |
$439.20
|
| Rate for Payer: Blue Shield of California Commercial |
$549.00
|
| Rate for Payer: Blue Shield of California EPN |
$398.21
|
| Rate for Payer: Cash Price |
$329.40
|
| 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: Dignity Health Commercial/Exchange |
$622.20
|
| Rate for Payer: Dignity Health Media |
$622.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$622.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$549.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.12
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: Riverside University Health System MISP |
$292.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$439.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$439.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$366.00
|
| Rate for Payer: United Healthcare All Other HMO |
$366.00
|
| Rate for Payer: United Healthcare HMO Rider |
$366.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$622.20
|
| Rate for Payer: Vantage Medical Group Senior |
$622.20
|
|
|
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: Blue Shield of California EPN |
$390.89
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.40
|
| Rate for Payer: United Healthcare All Other HMO |
$269.96
|
| Rate for Payer: United Healthcare HMO Rider |
$264.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.56
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.50
|
| Rate for Payer: Blue Distinction Transplant |
$228.00
|
| Rate for Payer: Blue Shield of California Commercial |
$239.02
|
| Rate for Payer: Blue Shield of California EPN |
$185.82
|
| Rate for Payer: Caremore Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Central Health Plan Commercial |
$304.00
|
| Rate for Payer: Cigna of CA HMO |
$243.20
|
| Rate for Payer: Cigna of CA PPO |
$281.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Media |
$12.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$323.00
|
| Rate for Payer: Global Benefits Group Commercial |
$228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$342.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$285.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: InnovAge PACE Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
| Rate for Payer: Networks By Design Commercial |
$247.00
|
| Rate for Payer: Prime Health Services Commercial |
$323.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Central Health Plan Commercial |
$304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.00
|
| Rate for Payer: Galaxy Health WC |
$323.00
|
| Rate for Payer: Global Benefits Group Commercial |
$228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.00
|
| Rate for Payer: Multiplan Commercial |
$285.00
|
| Rate for Payer: Networks By Design Commercial |
$247.00
|
| Rate for Payer: Prime Health Services Commercial |
$323.00
|
|
