|
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 |
$74.80
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| 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 Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| Rate for Payer: Cash Price |
$74.80
|
| 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 |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| 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 |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| 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 |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| 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 |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
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 |
$51.15
|
| Rate for Payer: Central Health Plan Commercial |
$74.40
|
| 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 Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.57
|
| 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 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 |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$201.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.62
|
| Rate for Payer: Blue Shield of California Commercial |
$56.45
|
| Rate for Payer: Blue Shield of California EPN |
$36.92
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cash Price |
$51.15
|
| 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 |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| 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 |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| 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 |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$79.05
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| 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 |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
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 |
$76.45
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| 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 Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.04
|
| 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 |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.63
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$76.45
|
| Rate for Payer: Cash Price |
$76.45
|
| Rate for Payer: Cash Price |
$76.45
|
| 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 |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| 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 |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| 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 |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| 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 |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
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 |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| 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 |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| 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 |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$696.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| 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 |
$22,815.81
|
| 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 |
$24,184.76
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,766.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
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 |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| Rate for Payer: Cash Price |
$10,786.05
|
| 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 |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| 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 |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$696.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| 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 |
$22,815.81
|
| Rate for Payer: Prime Health Services Commercial |
$16,669.35
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| 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 |
$17,712.00
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,410.60 |
| Max. Negotiated Rate |
$15,347.70 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Central Health Plan Commercial |
$13,642.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,821.20
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,347.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,497.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,555.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.60
|
| Rate for Payer: Multiplan Commercial |
$12,789.75
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$696.70 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Central Health Plan Commercial |
$13,642.40
|
| Rate for Payer: Cigna of CA HMO |
$11,084.45
|
| Rate for Payer: Cigna of CA PPO |
$12,619.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,347.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$696.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,410.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$12,789.75
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,231.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,231.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| 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 |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
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 |
$10,786.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,688.80
|
| 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 Permanente of CA Commercial/Self Funded |
$13,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,471.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,139.21
|
| 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 |
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 |
$10,786.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,688.80
|
| 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 Permanente of CA Commercial/Self Funded |
$13,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,471.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,139.21
|
| 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 M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,876.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,740.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,456.00
|
| Rate for Payer: Cigna of CA HMO |
$9,164.80
|
| Rate for Payer: Cigna of CA PPO |
$10,596.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,172.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,888.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,474.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,024.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,728.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,592.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,172.00
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,864.00 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,888.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,455.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,864.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
|
|
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 |
$14,821.20 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$9,057.40
|
| Rate for Payer: Cash Price |
$9,057.40
|
| Rate for Payer: Cash Price |
$9,057.40
|
| 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: 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: InnovAge PACE Commercial |
$8,234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,984.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,193.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,293.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,527.60
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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
|
|
|
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 |
$9,057.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,174.40
|
| 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 Permanente of CA Commercial/Self Funded |
$10,984.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,274.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,193.69
|
| 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 PRIMOBOOT BARIATRIC PRPL/NAVY
|
Facility
|
IP
|
$297.29
|
|
| Hospital Charge Code |
901698652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$267.56 |
| Rate for Payer: Adventist Health Commercial |
$59.46
|
| Rate for Payer: Cash Price |
$163.51
|
| Rate for Payer: Central Health Plan Commercial |
$237.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.92
|
| Rate for Payer: EPIC Health Plan Senior |
$118.92
|
| Rate for Payer: Galaxy Health WC |
$252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$178.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.46
|
| Rate for Payer: Multiplan Commercial |
$222.97
|
| Rate for Payer: Networks By Design Commercial |
$193.24
|
| Rate for Payer: Prime Health Services Commercial |
$252.70
|
|
|
HC PRIMOBOOT BARIATRIC PRPL/NAVY
|
Facility
|
OP
|
$297.29
|
|
| Hospital Charge Code |
901698652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$267.56 |
| Rate for Payer: Adventist Health Commercial |
$59.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.60
|
| Rate for Payer: Blue Shield of California Commercial |
$181.64
|
| Rate for Payer: Blue Shield of California EPN |
$118.62
|
| Rate for Payer: Cash Price |
$163.51
|
| Rate for Payer: Central Health Plan Commercial |
$237.83
|
| Rate for Payer: Cigna of CA HMO |
$190.27
|
| Rate for Payer: Cigna of CA PPO |
$219.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.92
|
| Rate for Payer: EPIC Health Plan Senior |
$118.92
|
| Rate for Payer: Galaxy Health WC |
$252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$178.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.56
|
| Rate for Payer: InnovAge PACE Commercial |
$148.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$222.97
|
| Rate for Payer: Networks By Design Commercial |
$193.24
|
| Rate for Payer: Prime Health Services Commercial |
$252.70
|
| Rate for Payer: Riverside University Health System MISP |
$118.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.65
|
| Rate for Payer: United Healthcare All Other HMO |
$148.65
|
| Rate for Payer: United Healthcare HMO Rider |
$148.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.70
|
| Rate for Payer: Vantage Medical Group Senior |
$252.70
|
|
|
HC PRIMOBOOT STD PURPLE/NAVY
|
Facility
|
OP
|
$268.17
|
|
| Hospital Charge Code |
901698653
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$241.35 |
| Rate for Payer: Adventist Health Commercial |
$53.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$163.85
|
| Rate for Payer: Blue Shield of California EPN |
$107.00
|
| Rate for Payer: Cash Price |
$147.49
|
| Rate for Payer: Central Health Plan Commercial |
$214.54
|
| Rate for Payer: Cigna of CA HMO |
$171.63
|
| Rate for Payer: Cigna of CA PPO |
$198.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.27
|
| Rate for Payer: EPIC Health Plan Senior |
$107.27
|
| Rate for Payer: Galaxy Health WC |
$227.94
|
| Rate for Payer: Global Benefits Group Commercial |
$160.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.35
|
| Rate for Payer: InnovAge PACE Commercial |
$134.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.72
|
| Rate for Payer: Multiplan Commercial |
$201.13
|
| Rate for Payer: Networks By Design Commercial |
$174.31
|
| Rate for Payer: Prime Health Services Commercial |
$227.94
|
| Rate for Payer: Riverside University Health System MISP |
$107.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.09
|
| Rate for Payer: United Healthcare All Other HMO |
$134.09
|
| Rate for Payer: United Healthcare HMO Rider |
$134.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.94
|
| Rate for Payer: Vantage Medical Group Senior |
$227.94
|
|
|
HC PRIMOBOOT STD PURPLE/NAVY
|
Facility
|
IP
|
$268.17
|
|
| Hospital Charge Code |
901698653
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$241.35 |
| Rate for Payer: Adventist Health Commercial |
$53.63
|
| Rate for Payer: Cash Price |
$147.49
|
| Rate for Payer: Central Health Plan Commercial |
$214.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.27
|
| Rate for Payer: EPIC Health Plan Senior |
$107.27
|
| Rate for Payer: Galaxy Health WC |
$227.94
|
| Rate for Payer: Global Benefits Group Commercial |
$160.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.63
|
| Rate for Payer: Multiplan Commercial |
$201.13
|
| Rate for Payer: Networks By Design Commercial |
$174.31
|
| Rate for Payer: Prime Health Services Commercial |
$227.94
|
|
|
HC PRIMOBOOT STD W/WEDGE PUR/NAVY
|
Facility
|
OP
|
$297.22
|
|
| Hospital Charge Code |
901698678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$267.50 |
| Rate for Payer: Adventist Health Commercial |
$59.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.56
|
| Rate for Payer: Blue Shield of California Commercial |
$181.60
|
| Rate for Payer: Blue Shield of California EPN |
$118.59
|
| Rate for Payer: Cash Price |
$163.47
|
| Rate for Payer: Central Health Plan Commercial |
$237.78
|
| Rate for Payer: Cigna of CA HMO |
$190.22
|
| Rate for Payer: Cigna of CA PPO |
$219.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Senior |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.64
|
| Rate for Payer: Global Benefits Group Commercial |
$178.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.50
|
| Rate for Payer: InnovAge PACE Commercial |
$148.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.05
|
| Rate for Payer: Multiplan Commercial |
$222.91
|
| Rate for Payer: Networks By Design Commercial |
$193.19
|
| Rate for Payer: Prime Health Services Commercial |
$252.64
|
| Rate for Payer: Riverside University Health System MISP |
$118.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.61
|
| Rate for Payer: United Healthcare All Other HMO |
$148.61
|
| Rate for Payer: United Healthcare HMO Rider |
$148.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.64
|
| Rate for Payer: Vantage Medical Group Senior |
$252.64
|
|
|
HC PRIMOBOOT STD W/WEDGE PUR/NAVY
|
Facility
|
IP
|
$297.22
|
|
| Hospital Charge Code |
901698678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$267.50 |
| Rate for Payer: Adventist Health Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$163.47
|
| Rate for Payer: Central Health Plan Commercial |
$237.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Senior |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.64
|
| Rate for Payer: Global Benefits Group Commercial |
$178.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.44
|
| Rate for Payer: Multiplan Commercial |
$222.91
|
| Rate for Payer: Networks By Design Commercial |
$193.19
|
| Rate for Payer: Prime Health Services Commercial |
$252.64
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
IP
|
$5,678.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,135.60 |
| Max. Negotiated Rate |
$5,110.20 |
| Rate for Payer: Adventist Health Commercial |
$1,135.60
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,542.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,271.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,271.20
|
| Rate for Payer: Galaxy Health WC |
$4,826.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,110.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,787.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,163.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,514.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.60
|
| Rate for Payer: Multiplan Commercial |
$4,258.50
|
| Rate for Payer: Networks By Design Commercial |
$3,690.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,826.30
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
OP
|
$5,678.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.91 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,135.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Cash Price |
$3,122.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,542.40
|
| Rate for Payer: Cigna of CA HMO |
$3,633.92
|
| Rate for Payer: Cigna of CA PPO |
$4,201.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$4,826.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,110.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4,446.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,787.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,972.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$4,258.50
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,690.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,826.30
|
| Rate for Payer: Prime Health Services Medicare |
$3,142.12
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,406.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,839.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,839.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,839.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
|
IP
|
$10,012.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
900501677
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,002.40 |
| Max. Negotiated Rate |
$9,010.80 |
| Rate for Payer: Adventist Health Commercial |
$2,002.40
|
| Rate for Payer: Cash Price |
$5,506.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,009.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,004.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,004.80
|
| Rate for Payer: Galaxy Health WC |
$8,510.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,007.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,010.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,678.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,814.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,197.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,002.40
|
| Rate for Payer: Multiplan Commercial |
$7,509.00
|
| Rate for Payer: Networks By Design Commercial |
$6,507.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,510.20
|
|
