|
HC PREVNAR ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890224
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC PRGRM DEV EVAL DUAL LEAD IMPL DFIB
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
900200304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRM DEV EVAL DUAL LEAD IMPL DFIB
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
900200304
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PRGRM DEV EVAL DUAL LEAD PACEMAKER
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93280
|
| Hospital Charge Code |
900200301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRM DEV EVAL DUAL LEAD PACEMAKER
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93280
|
| Hospital Charge Code |
900200301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PRGRM DEV EVAL MULT LEAD IMPL DFIB
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
900200305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PRGRM DEV EVAL MULT LEAD IMPL DFIB
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
900200305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRM DEV EVAL MULT LEAD PACEMAKER
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93281
|
| Hospital Charge Code |
900200302
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PRGRM DEV EVAL MULT LEAD PACEMAKER
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93281
|
| Hospital Charge Code |
900200302
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRM DEV EVAL SNGL LEAD IMPL DFIB
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
900200303
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRM DEV EVAL SNGL LEAD IMPL DFIB
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
900200303
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PRGRM DEV EVAL SNGL LEAD PACEMAKER
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
900200300
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PRGRM DEV EVAL SNGL LEAD PACEMAKER
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
900200300
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRM DEV EVAL SUBQ CARDIAC RHTHM
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
900200306
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC PRGRM DEV EVAL SUBQ CARDIAC RHTHM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
900200306
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.11
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$201.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.10
|
| Rate for Payer: Blue Shield of California Commercial |
$58.59
|
| Rate for Payer: Blue Shield of California EPN |
$36.92
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Cigna of CA HMO |
$59.52
|
| Rate for Payer: Cigna of CA PPO |
$68.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.20
|
| Rate for Payer: EPIC Health Plan Senior |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$79.05
|
| Rate for Payer: Global Benefits Group Commercial |
$55.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: Networks By Design Commercial |
$60.45
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Senior |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$1,136.00 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$97.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Prime Health Services Medicare |
$50.88
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,922.20 |
| Max. Negotiated Rate |
$17,649.90 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Central Health Plan Commercial |
$15,688.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,727.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,844.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,844.40
|
| Rate for Payer: Galaxy Health WC |
$16,669.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,766.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,649.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,452.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,570.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.20
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: Networks By Design Commercial |
$12,747.15
|
| Rate for Payer: Prime Health Services Commercial |
$16,669.35
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,922.20 |
| Max. Negotiated Rate |
$17,649.90 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Central Health Plan Commercial |
$15,688.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,727.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,844.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,844.40
|
| Rate for Payer: Galaxy Health WC |
$16,669.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,766.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,649.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,452.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,570.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.20
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: Networks By Design Commercial |
$12,747.15
|
| Rate for Payer: Prime Health Services Commercial |
$16,669.35
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$696.70 |
| Max. Negotiated Rate |
$38,902.96 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| 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 |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Central Health Plan Commercial |
$15,688.80
|
| Rate for Payer: Cigna of CA HMO |
$12,747.15
|
| Rate for Payer: Cigna of CA PPO |
$14,512.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,727.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$16,669.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,766.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,649.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$696.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,452.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: Networks By Design Commercial |
$12,747.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$16,669.35
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,766.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,766.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,805.50
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$696.70 |
| Max. Negotiated Rate |
$38,902.96 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| 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 |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Central Health Plan Commercial |
$15,688.80
|
| Rate for Payer: Cigna of CA HMO |
$12,551.04
|
| Rate for Payer: Cigna of CA PPO |
$14,512.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,727.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$16,669.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,766.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,649.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$696.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,452.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$12,747.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$16,669.35
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,766.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,805.50
|
| 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 |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$16,468.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,293.60 |
| Max. Negotiated Rate |
$14,821.20 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Central Health Plan Commercial |
$13,174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,527.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,587.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,587.20
|
| Rate for Payer: Galaxy Health WC |
$13,997.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,821.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,457.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,716.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,293.60
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
| Rate for Payer: Networks By Design Commercial |
$10,704.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,997.80
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$16,468.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,057.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,351.00
|
| 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: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Central Health Plan Commercial |
$13,174.40
|
| Rate for Payer: Cigna of CA HMO |
$10,539.52
|
| Rate for Payer: Cigna of CA PPO |
$12,186.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,997.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,997.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,527.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,587.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,587.20
|
| Rate for Payer: Galaxy Health WC |
$13,997.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,821.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,474.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,457.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,629.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,716.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,293.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,527.60
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
| Rate for Payer: Networks By Design Commercial |
$10,704.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,997.80
|
| Rate for Payer: Riverside University Health System MISP |
$6,587.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,880.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,234.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Senior |
$13,997.80
|
|
