|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC REM AUTON ALG INSLN DATA COLL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC REM AUTON ALG INSLN DATA COLL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.34
|
| 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 |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.97
|
| Rate for Payer: Blue Shield of California Commercial |
$77.35
|
| Rate for Payer: Blue Shield of California EPN |
$48.68
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| 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 |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| 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 |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| 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 |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| 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 REMEDE SYSTEM DEVICE CODE
|
Facility
|
OP
|
$115,230.00
|
|
|
Service Code
|
CPT C1823
|
| Hospital Charge Code |
906811823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,046.00 |
| Max. Negotiated Rate |
$103,707.00 |
| Rate for Payer: Adventist Health Commercial |
$23,046.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97,945.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63,376.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86,422.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52,614.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63,192.13
|
| Rate for Payer: Blue Shield of California Commercial |
$92,414.46
|
| Rate for Payer: Blue Shield of California EPN |
$58,075.92
|
| Rate for Payer: Cash Price |
$51,853.50
|
| Rate for Payer: Central Health Plan Commercial |
$92,184.00
|
| Rate for Payer: Cigna of CA HMO |
$80,661.00
|
| Rate for Payer: Cigna of CA PPO |
$80,661.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97,945.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$97,945.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97,945.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46,092.00
|
| Rate for Payer: Galaxy Health WC |
$97,945.50
|
| Rate for Payer: Global Benefits Group Commercial |
$69,138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103,707.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73,171.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67,985.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,046.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80,661.00
|
| Rate for Payer: Multiplan Commercial |
$86,422.50
|
| Rate for Payer: Networks By Design Commercial |
$57,615.00
|
| Rate for Payer: Prime Health Services Commercial |
$97,945.50
|
| Rate for Payer: Riverside University Health System MISP |
$46,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69,138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69,138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$42,093.52
|
| Rate for Payer: United Healthcare HMO Rider |
$41,183.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,737.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97,945.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97,945.50
|
| Rate for Payer: Vantage Medical Group Senior |
$97,945.50
|
|
|
HC REMEDE SYSTEM DEVICE CODE
|
Facility
|
IP
|
$115,230.00
|
|
|
Service Code
|
CPT C1823
|
| Hospital Charge Code |
906811823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,046.00 |
| Max. Negotiated Rate |
$103,707.00 |
| Rate for Payer: Adventist Health Commercial |
$23,046.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92,414.46
|
| Rate for Payer: Blue Shield of California EPN |
$58,075.92
|
| Rate for Payer: Cash Price |
$51,853.50
|
| Rate for Payer: Central Health Plan Commercial |
$92,184.00
|
| Rate for Payer: Cigna of CA HMO |
$80,661.00
|
| Rate for Payer: Cigna of CA PPO |
$80,661.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80,661.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46,092.00
|
| Rate for Payer: Galaxy Health WC |
$97,945.50
|
| Rate for Payer: Global Benefits Group Commercial |
$69,138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103,707.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73,171.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67,985.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,046.00
|
| Rate for Payer: Multiplan Commercial |
$86,422.50
|
| Rate for Payer: Networks By Design Commercial |
$57,615.00
|
| Rate for Payer: Prime Health Services Commercial |
$97,945.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$42,093.52
|
| Rate for Payer: United Healthcare HMO Rider |
$41,183.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,737.82
|
|
|
HC REM INTERROG SCRMS UP TO 30 DAYS
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
900200312
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$161.68 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$48.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.68
|
| 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 |
$159.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.64
|
| Rate for Payer: Blue Shield of California Commercial |
$74.81
|
| Rate for Payer: Blue Shield of California EPN |
$47.08
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| 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 |
$82.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| 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 |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| 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 REM INTERROG SCRMS UP TO 30 DAYS
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
900200312
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Senior |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
IP
|
$9,538.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,907.60 |
| Max. Negotiated Rate |
$8,584.20 |
| Rate for Payer: Adventist Health Commercial |
$1,907.60
|
| Rate for Payer: Cash Price |
$4,292.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,630.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,815.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,815.20
|
| Rate for Payer: Galaxy Health WC |
$8,107.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,722.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,584.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,056.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,627.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,907.60
|
| Rate for Payer: Multiplan Commercial |
$7,153.50
|
| Rate for Payer: Networks By Design Commercial |
$6,199.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,107.30
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$9,538.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$8,584.20 |
| Rate for Payer: Adventist Health Commercial |
$1,907.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,792.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,618.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,548.25
|
| 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 |
$4,292.10
|
| Rate for Payer: Cash Price |
$4,292.10
|
| Rate for Payer: Cash Price |
$4,292.10
|
| Rate for Payer: Cash Price |
$4,292.10
|
| Rate for Payer: Central Health Plan Commercial |
$7,630.40
|
| Rate for Payer: Cigna of CA HMO |
$6,104.32
|
| Rate for Payer: Cigna of CA PPO |
$7,058.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,676.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$8,107.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,722.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,584.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,056.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,907.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$7,153.50
|
| Rate for Payer: Networks By Design Commercial |
$6,199.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$8,107.30
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,722.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,722.80
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC REMOVAL OF ANAL TAB
|
Facility
|
IP
|
$4,601.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
904000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$920.20 |
| Max. Negotiated Rate |
$4,140.90 |
| Rate for Payer: Adventist Health Commercial |
$920.20
|
| Rate for Payer: Cash Price |
$2,070.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,680.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,220.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,840.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,840.40
|
| Rate for Payer: Galaxy Health WC |
$3,910.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,760.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,140.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,921.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,714.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.20
|
| Rate for Payer: Multiplan Commercial |
$3,450.75
|
| Rate for Payer: Networks By Design Commercial |
$2,990.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,910.85
|
|
|
HC REMOVAL OF ANAL TAB
|
Facility
|
OP
|
$4,601.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
904000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.81 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$920.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$660.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,917.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,835.80
|
| Rate for Payer: Cash Price |
$2,070.45
|
| Rate for Payer: Cash Price |
$2,070.45
|
| Rate for Payer: Cash Price |
$2,070.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,680.80
|
| Rate for Payer: Cigna of CA HMO |
$2,944.64
|
| Rate for Payer: Cigna of CA PPO |
$3,404.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,220.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$3,910.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,760.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,140.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,921.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$3,450.75
|
| Rate for Payer: Networks By Design Commercial |
$2,990.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,910.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,760.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,760.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,300.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,300.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,300.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$13,020.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,604.00 |
| Max. Negotiated Rate |
$11,718.00 |
| Rate for Payer: Adventist Health Commercial |
$2,604.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,416.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,114.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,208.00
|
| Rate for Payer: Galaxy Health WC |
$11,067.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,812.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,718.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,681.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Multiplan Commercial |
$9,765.00
|
| Rate for Payer: Networks By Design Commercial |
$8,463.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,067.00
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
OP
|
$13,020.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,718.00 |
| Rate for Payer: Adventist Health Commercial |
$5,338.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,751.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,416.00
|
| Rate for Payer: Cigna of CA HMO |
$8,332.80
|
| Rate for Payer: Cigna of CA PPO |
$9,634.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,114.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$11,067.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,812.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,718.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,413.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$9,765.00
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$8,463.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$11,067.00
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,812.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,812.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
OP
|
$13,020.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,718.00 |
| Rate for Payer: Adventist Health Commercial |
$2,604.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,416.00
|
| Rate for Payer: Cigna of CA HMO |
$8,332.80
|
| Rate for Payer: Cigna of CA PPO |
$9,634.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,114.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$11,067.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,812.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,718.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,413.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$9,765.00
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$8,463.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$11,067.00
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,812.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,510.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,510.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$13,020.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,604.00 |
| Max. Negotiated Rate |
$11,718.00 |
| Rate for Payer: Adventist Health Commercial |
$2,604.00
|
| Rate for Payer: Cash Price |
$5,859.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,416.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,114.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,208.00
|
| Rate for Payer: Galaxy Health WC |
$11,067.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,812.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,718.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,681.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Multiplan Commercial |
$9,765.00
|
| Rate for Payer: Networks By Design Commercial |
$8,463.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,067.00
|
|
|
HC REMOVAL OF JP DRAIN CATHETER
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
906812000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$2,624.40 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,332.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,041.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,166.40
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,624.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,851.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,720.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.20
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
|
|
HC REMOVAL OF JP DRAIN CATHETER
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
906812000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$583.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,411.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,696.24
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,332.80
|
| Rate for Payer: Cigna of CA HMO |
$1,866.24
|
| Rate for Payer: Cigna of CA PPO |
$2,157.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,041.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$2,478.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,749.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,624.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,851.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,895.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,478.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,458.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$17,351.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,470.20 |
| Max. Negotiated Rate |
$15,615.90 |
| Rate for Payer: Adventist Health Commercial |
$3,470.20
|
| Rate for Payer: Cash Price |
$7,807.95
|
| Rate for Payer: Central Health Plan Commercial |
$13,880.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,145.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,940.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,940.40
|
| Rate for Payer: Galaxy Health WC |
$14,748.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,410.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,615.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,017.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,237.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,470.20
|
| Rate for Payer: Multiplan Commercial |
$13,013.25
|
| Rate for Payer: Networks By Design Commercial |
$11,278.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,748.35
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$17,351.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,470.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,748.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,543.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,013.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$7,807.95
|
| Rate for Payer: Cash Price |
$7,807.95
|
| Rate for Payer: Cash Price |
$7,807.95
|
| Rate for Payer: Central Health Plan Commercial |
$13,880.80
|
| Rate for Payer: Cigna of CA HMO |
$11,104.64
|
| Rate for Payer: Cigna of CA PPO |
$12,839.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,748.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,748.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,748.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,145.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,940.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,940.40
|
| Rate for Payer: Galaxy Health WC |
$14,748.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,410.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,615.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,017.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,237.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,470.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,145.70
|
| Rate for Payer: Multiplan Commercial |
$13,013.25
|
| Rate for Payer: Networks By Design Commercial |
$11,278.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,748.35
|
| Rate for Payer: Riverside University Health System MISP |
$6,940.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,410.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,675.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,748.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,748.35
|
| Rate for Payer: Vantage Medical Group Senior |
$14,748.35
|
|
|
HC REMOVE ARM/ELBOW LESION LT 3 CM
|
Facility
|
IP
|
$8,074.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
904000005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,614.80 |
| Max. Negotiated Rate |
$7,266.60 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,651.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,229.60
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,126.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,763.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
|
|
HC REMOVE ARM/ELBOW LESION LT 3 CM
|
Facility
|
OP
|
$8,074.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
904000005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.91 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,459.20
|
| Rate for Payer: Cigna of CA HMO |
$5,167.36
|
| Rate for Payer: Cigna of CA PPO |
$5,974.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,651.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$6,862.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,844.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,266.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$115.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,126.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,248.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$6,862.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,844.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,037.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$10,888.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.81 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$2,177.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: Cigna of CA HMO |
$6,968.32
|
| Rate for Payer: Cigna of CA PPO |
$8,057.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,913.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,444.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,444.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,444.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$10,888.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$210.81 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$4,464.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,417.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: Cigna of CA HMO |
$6,968.32
|
| Rate for Payer: Cigna of CA PPO |
$8,057.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,913.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
| Rate for Payer: Prime Health Services Medicare |
$3,146.34
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,265.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,532.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$10,888.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,177.60 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$2,177.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,355.20
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,913.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,423.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$10,888.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,177.60 |
| Max. Negotiated Rate |
$9,799.20 |
| Rate for Payer: Adventist Health Commercial |
$2,177.60
|
| Rate for Payer: Cash Price |
$4,899.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,710.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,355.20
|
| Rate for Payer: Galaxy Health WC |
$9,254.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,799.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,913.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,423.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.60
|
| Rate for Payer: Multiplan Commercial |
$8,166.00
|
| Rate for Payer: Networks By Design Commercial |
$7,077.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,254.80
|
|
