|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
905352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.46
|
| Rate for Payer: Blue Shield of California Commercial |
$738.99
|
| Rate for Payer: Blue Shield of California EPN |
$481.82
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.85
|
| Rate for Payer: InnovAge PACE Commercial |
$478.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Riverside University Health System MISP |
$382.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Blue Shield of California Commercial |
$738.99
|
| Rate for Payer: Blue Shield of California EPN |
$481.82
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
|
|
HC REINFORCED SOLID STIRRUP ADDITION LE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT L2260
|
| Hospital Charge Code |
915352260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$860.40 |
| Rate for Payer: Adventist Health Commercial |
$391.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$525.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.46
|
| Rate for Payer: Blue Shield of California Commercial |
$738.99
|
| Rate for Payer: Blue Shield of California EPN |
$481.82
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Central Health Plan Commercial |
$764.80
|
| Rate for Payer: Cigna of CA HMO |
$669.20
|
| Rate for Payer: Cigna of CA PPO |
$669.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$812.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$812.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$812.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$860.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$276.85
|
| Rate for Payer: InnovAge PACE Commercial |
$478.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.20
|
| Rate for Payer: Multiplan Commercial |
$717.00
|
| Rate for Payer: Networks By Design Commercial |
$478.00
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Riverside University Health System MISP |
$382.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.79
|
| Rate for Payer: United Healthcare All Other HMO |
$349.23
|
| Rate for Payer: United Healthcare HMO Rider |
$341.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$812.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$812.60
|
| Rate for Payer: Vantage Medical Group Senior |
$812.60
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,566.80 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$3,566.80
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,133.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,133.60
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,895.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,794.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,039.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$7,311.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: Cigna of CA HMO |
$11,413.76
|
| Rate for Payer: Cigna of CA PPO |
$13,197.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,895.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,700.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,700.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,566.80 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$3,566.80
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,133.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,133.60
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,895.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,794.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,039.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$17,834.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$16,050.60 |
| Rate for Payer: Adventist Health Commercial |
$3,566.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Cash Price |
$8,025.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,267.20
|
| Rate for Payer: Cigna of CA HMO |
$11,413.76
|
| Rate for Payer: Cigna of CA PPO |
$13,197.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$15,158.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,700.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,050.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,895.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,566.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$13,375.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$11,592.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.90
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,700.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,917.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,917.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,917.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,917.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC REM AUTON ALG INSLN CAL SETUP
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 0740T
|
| Hospital Charge Code |
902500740
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.46
|
| Rate for Payer: Blue Shield of California Commercial |
$122.20
|
| Rate for Payer: Blue Shield of California EPN |
$79.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| 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: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| 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 |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| 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 |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.09
|
| 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 |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.65
|
| Rate for Payer: Blue Shield of California Commercial |
$74.54
|
| 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 |
$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 |
$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 |
$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 |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| 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 |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| 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 |
$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 |
$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 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 |
$63,802.85
|
| Rate for Payer: Blue Shield of California Commercial |
$89,072.79
|
| 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: 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: InnovAge PACE Commercial |
$57,615.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,858.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71,327.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23,046.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80,661.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$89,072.79
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$76,858.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,902.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71,327.37
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.04
|
| 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 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 |
$159.81 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.66
|
| 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 |
$159.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.30
|
| Rate for Payer: Blue Shield of California Commercial |
$72.10
|
| 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 |
$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 |
$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 |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.46
|
| 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 |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| 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 |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| 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 |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.00
|
| Rate for Payer: United Healthcare All Other HMO |
$59.00
|
| Rate for Payer: United Healthcare HMO Rider |
$59.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.00
|
| 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 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 |
$198.80 |
| Max. Negotiated Rate |
$8,584.20 |
| Rate for Payer: Adventist Health Commercial |
$1,907.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,792.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,618.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,601.67
|
| 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 |
$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 |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| 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 |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,361.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,907.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| 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 |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,107.30
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| 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 |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$6,361.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,633.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,904.02
|
| 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
|
IP
|
$8,294.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,658.80 |
| Max. Negotiated Rate |
$7,464.60 |
| Rate for Payer: Adventist Health Commercial |
$1,658.80
|
| Rate for Payer: Cash Price |
$3,732.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,317.60
|
| Rate for Payer: Galaxy Health WC |
$7,049.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,976.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,464.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,160.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,133.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.80
|
| Rate for Payer: Multiplan Commercial |
$6,220.50
|
| Rate for Payer: Networks By Design Commercial |
$5,391.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,049.90
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$8,294.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,658.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,036.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,015.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,871.07
|
| 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 |
$3,732.30
|
| Rate for Payer: Cash Price |
$3,732.30
|
| Rate for Payer: Cash Price |
$3,732.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,635.20
|
| Rate for Payer: Cigna of CA HMO |
$5,308.16
|
| Rate for Payer: Cigna of CA PPO |
$6,137.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$7,049.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,976.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,464.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$6,220.50
|
| Rate for Payer: Networks By Design Commercial |
$5,391.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,049.90
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,976.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,976.40
|
| 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 |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$3,068.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,752.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,848.02
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$920.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,498.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,811.21
|
| 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 |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| 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 |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,068.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| 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 |
$1,498.14
|
| Rate for Payer: Prime Health Services Commercial |
$3,910.85
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| 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 |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| 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 |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| 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 |
$4,865.48
|
| 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 |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| 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 |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$8,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,960.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,059.38
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$8,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,960.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,059.38
|
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| 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 |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| 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 |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| 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 |
$4,865.48
|
| 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 |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| 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 |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
