|
HC REM AUTON ALG INSLN DATA COLL
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Central Health Plan Commercial |
$82.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.20
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.60
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
|
|
HC REM AUTON ALG INSLN DATA COLL
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 0741T
|
| Hospital Charge Code |
902500741
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$47.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$262.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.85
|
| Rate for Payer: Blue Distinction Transplant |
$61.80
|
| Rate for Payer: Blue Shield of California Commercial |
$64.79
|
| Rate for Payer: Blue Shield of California EPN |
$50.37
|
| Rate for Payer: Caremore Medicare Advantage |
$47.12
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Central Health Plan Commercial |
$82.40
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Media |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$77.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.12
|
| Rate for Payer: InnovAge PACE Commercial |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Prime Health Services Medicare |
$49.95
|
| Rate for Payer: Riverside University Health System MISP |
$51.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
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: 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 |
$63,376.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52,614.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64,183.11
|
| Rate for Payer: Blue Distinction Transplant |
$69,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$86,422.50
|
| Rate for Payer: Blue Shield of California EPN |
$62,685.12
|
| 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 Media |
$97,945.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$97,945.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,092.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$86,422.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40,330.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,858.41
|
| 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: 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 |
$57,615.00
|
| Rate for Payer: United Healthcare All Other HMO |
$57,615.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57,615.00
|
| 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: Blue Shield of California EPN |
$61,532.82
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$23,046.00
|
| Rate for Payer: Multiplan Commercial |
$86,422.50
|
| Rate for Payer: Prime Health Services Commercial |
$97,945.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,510.85
|
| Rate for Payer: United Healthcare All Other HMO |
$42,496.82
|
| Rate for Payer: United Healthcare HMO Rider |
$41,574.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38,025.90
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
IP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,442.40 |
| Max. Negotiated Rate |
$6,490.80 |
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,769.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,884.80
|
| Rate for Payer: Galaxy Health WC |
$6,130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,490.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,810.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,747.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.40
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
| Rate for Payer: Networks By Design Commercial |
$4,687.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,130.20
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
IP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,442.40 |
| Max. Negotiated Rate |
$6,490.80 |
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,769.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,884.80
|
| Rate for Payer: Galaxy Health WC |
$6,130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,490.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,810.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,747.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.40
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
| Rate for Payer: Networks By Design Commercial |
$4,687.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,130.20
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803800
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,379.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,492.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,260.85
|
| Rate for Payer: Blue Distinction Transplant |
$4,327.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,769.60
|
| Rate for Payer: Cigna of CA HMO |
$4,615.68
|
| Rate for Payer: Cigna of CA PPO |
$5,336.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$6,130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,490.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,409.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,810.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
| Rate for Payer: Networks By Design Commercial |
$4,687.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,130.20
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,327.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,327.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,379.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,492.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,260.85
|
| Rate for Payer: Blue Distinction Transplant |
$4,327.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,769.60
|
| Rate for Payer: Cigna of CA HMO |
$4,615.68
|
| Rate for Payer: Cigna of CA PPO |
$5,336.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$6,130.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,490.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,409.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,810.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
| Rate for Payer: Networks By Design Commercial |
$4,687.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,130.20
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,327.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,327.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC REMOVAL OF ANAL TAB
|
Facility
|
OP
|
$3,479.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
904000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,087.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,188.29
|
| Rate for Payer: Blue Shield of California EPN |
$1,701.23
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Cash Price |
$1,565.55
|
| Rate for Payer: Cash Price |
$1,565.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,783.20
|
| Rate for Payer: Cigna of CA HMO |
$2,226.56
|
| Rate for Payer: Cigna of CA PPO |
$2,574.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$2,957.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,087.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,131.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,609.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,432.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: InnovAge PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,320.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$695.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$2,609.25
|
| Rate for Payer: Networks By Design Commercial |
$2,261.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,957.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Riverside University Health System MISP |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,087.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,087.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,739.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,739.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,739.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,739.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC REMOVAL OF ANAL TAB
|
Facility
|
IP
|
$3,479.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
904000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$3,131.10 |
| Rate for Payer: Cash Price |
$1,565.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,783.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,391.60
|
| Rate for Payer: Galaxy Health WC |
$2,957.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,087.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,131.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,320.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,325.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$695.80
|
| Rate for Payer: Multiplan Commercial |
$2,609.25
|
| Rate for Payer: Networks By Design Commercial |
$2,261.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,957.15
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$9,845.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,969.00 |
| Max. Negotiated Rate |
$8,860.50 |
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,938.00
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,750.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$9,845.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,969.00 |
| Max. Negotiated Rate |
$8,860.50 |
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,938.00
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,750.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
OP
|
$9,845.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,860.50 |
| 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 |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,907.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: Cigna of CA PPO |
$7,285.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,383.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health System MISP |
$5,238.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,907.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,922.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,922.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,922.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,922.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
OP
|
$9,845.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$613.28 |
| Max. Negotiated Rate |
$8,860.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,762.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,907.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,192.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,814.20
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Cash Price |
$4,430.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,876.00
|
| Rate for Payer: Cigna of CA HMO |
$6,300.80
|
| Rate for Payer: Cigna of CA PPO |
$7,285.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$8,368.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,907.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,860.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,383.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,858.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,566.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,969.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$7,383.75
|
| Rate for Payer: Networks By Design Commercial |
$6,399.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,368.25
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health System MISP |
$5,238.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,907.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,907.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,922.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,922.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,922.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,922.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,297.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Central Health Plan Commercial |
$17,189.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,594.80
|
| Rate for Payer: Galaxy Health WC |
$18,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,892.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,338.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,186.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,297.40
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,263.95
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$19,338.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$884.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,817.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,892.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Central Health Plan Commercial |
$17,189.60
|
| Rate for Payer: Cigna of CA PPO |
$15,900.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Dignity Health Media |
$18,263.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,263.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,594.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,594.80
|
| Rate for Payer: Galaxy Health WC |
$18,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,892.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,338.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,115.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,520.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,297.40
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
| Rate for Payer: Networks By Design Commercial |
$13,966.55
|
| Rate for Payer: Prime Health Services Commercial |
$18,263.95
|
| Rate for Payer: Riverside University Health System MISP |
$8,594.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,892.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,263.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18,263.95
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,297.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Central Health Plan Commercial |
$17,189.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,594.80
|
| Rate for Payer: Galaxy Health WC |
$18,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,892.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,338.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,186.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,297.40
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,263.95
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$19,338.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$884.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,817.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,892.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Central Health Plan Commercial |
$17,189.60
|
| Rate for Payer: Cigna of CA PPO |
$15,900.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Dignity Health Media |
$18,263.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,263.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,594.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,594.80
|
| Rate for Payer: Galaxy Health WC |
$18,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,892.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,338.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,115.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,520.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,331.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,297.40
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
| Rate for Payer: Networks By Design Commercial |
$13,966.55
|
| Rate for Payer: Prime Health Services Commercial |
$18,263.95
|
| Rate for Payer: Riverside University Health System MISP |
$8,594.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,892.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,263.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18,263.95
|
|
|
HC REMOVE ARM/ELBOW LESION LT 3 CM
|
Facility
|
IP
|
$6,105.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
904000005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$5,494.50 |
| Rate for Payer: Cash Price |
$2,747.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,442.00
|
| Rate for Payer: Galaxy Health WC |
$5,189.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,494.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,072.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,326.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.00
|
| Rate for Payer: Multiplan Commercial |
$4,578.75
|
| Rate for Payer: Networks By Design Commercial |
$3,968.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,189.25
|
|
|
HC REMOVE ARM/ELBOW LESION LT 3 CM
|
Facility
|
OP
|
$6,105.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
904000005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,663.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,747.25
|
| Rate for Payer: Cash Price |
$2,747.25
|
| Rate for Payer: Central Health Plan Commercial |
$4,884.00
|
| Rate for Payer: Cigna of CA PPO |
$4,517.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$5,189.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,494.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,578.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,072.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$4,578.75
|
| Rate for Payer: Networks By Design Commercial |
$3,968.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,189.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,663.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$8,795.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,759.00 |
| Max. Negotiated Rate |
$7,915.50 |
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,518.00
|
| Rate for Payer: Galaxy Health WC |
$7,475.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,277.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,915.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,866.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,350.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.00
|
| Rate for Payer: Multiplan Commercial |
$6,596.25
|
| Rate for Payer: Networks By Design Commercial |
$5,716.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,475.75
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$8,795.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,759.00 |
| Max. Negotiated Rate |
$7,915.50 |
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,518.00
|
| Rate for Payer: Galaxy Health WC |
$7,475.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,277.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,915.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,866.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,350.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.00
|
| Rate for Payer: Multiplan Commercial |
$6,596.25
|
| Rate for Payer: Networks By Design Commercial |
$5,716.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,475.75
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$8,795.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,911.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,532.06
|
| Rate for Payer: Blue Shield of California EPN |
$4,300.76
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,036.00
|
| Rate for Payer: Cigna of CA HMO |
$5,628.80
|
| Rate for Payer: Cigna of CA PPO |
$6,508.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$7,475.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,277.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,915.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,804.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,866.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$6,596.25
|
| Rate for Payer: Networks By Design Commercial |
$5,716.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,475.75
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health System MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,277.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,277.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,397.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,397.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,397.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,397.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$8,795.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,277.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Cash Price |
$3,957.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,036.00
|
| Rate for Payer: Cigna of CA PPO |
$6,508.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$7,475.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,277.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,915.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,866.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$6,596.25
|
| Rate for Payer: Networks By Design Commercial |
$5,716.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,475.75
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health System MISP |
$3,202.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,277.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,397.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,397.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,397.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,397.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REMOVE CERCLAGE SUTURE
|
Facility
|
IP
|
$9,308.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
902400749
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,861.60 |
| Max. Negotiated Rate |
$8,377.20 |
| Rate for Payer: Cash Price |
$4,188.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,446.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,723.20
|
| Rate for Payer: Galaxy Health WC |
$7,911.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,584.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,377.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,208.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,546.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,861.60
|
| Rate for Payer: Multiplan Commercial |
$6,981.00
|
| Rate for Payer: Networks By Design Commercial |
$6,050.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,911.80
|
|
