|
HC SYTM TORTLEAIR HEAD REPOSITIONING LRG 41-46CM
|
Facility
|
OP
|
$176.75
|
|
| Hospital Charge Code |
901607217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$150.24 |
| Rate for Payer: Adventist Health Commercial |
$35.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.54
|
| Rate for Payer: Cash Price |
$79.54
|
| Rate for Payer: Cigna of CA HMO |
$113.12
|
| Rate for Payer: Cigna of CA PPO |
$130.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.70
|
| Rate for Payer: EPIC Health Plan Senior |
$70.70
|
| Rate for Payer: Galaxy Health WC |
$150.24
|
| Rate for Payer: Global Benefits Group Commercial |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.72
|
| Rate for Payer: Multiplan Commercial |
$141.40
|
| Rate for Payer: Networks By Design Commercial |
$114.89
|
| Rate for Payer: Prime Health Services Commercial |
$150.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.38
|
| Rate for Payer: United Healthcare All Other HMO |
$88.38
|
| Rate for Payer: United Healthcare HMO Rider |
$88.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.24
|
| Rate for Payer: Vantage Medical Group Senior |
$150.24
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING MED 38-41CM
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
901607216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING MED 38-41CM
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
901607216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.84
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$135.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.62
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.88
|
| Rate for Payer: United Healthcare All Other HMO |
$91.88
|
| Rate for Payer: United Healthcare HMO Rider |
$91.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.19
|
| Rate for Payer: Vantage Medical Group Senior |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING SM 33-38CM
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
901607215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.84
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$135.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.62
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.88
|
| Rate for Payer: United Healthcare All Other HMO |
$91.88
|
| Rate for Payer: United Healthcare HMO Rider |
$91.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.19
|
| Rate for Payer: Vantage Medical Group Senior |
$156.19
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING SM 33-38CM
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
901607215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Cash Price |
$82.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.10
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
|
|
HC SYVEK EXCEL HEMOSTASIS PAD
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
906812424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC SYVEK EXCEL HEMOSTASIS PAD
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
906812424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC SYVEK NT HEMOSTASIS PAD
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
906812425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC SYVEK NT HEMOSTASIS PAD
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
906812425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.32
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$259.84
|
| Rate for Payer: Cigna of CA PPO |
$300.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC TAGGED WBC WB SCAN
|
Facility
|
OP
|
$3,744.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
909301443
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,455.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,291.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,512.58
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cigna of CA HMO |
$2,396.16
|
| Rate for Payer: Cigna of CA PPO |
$2,770.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,317.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,620.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,620.80
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Networks By Design Commercial |
$2,433.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,872.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,872.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
|
HC TAGGED WBC WB SCAN
|
Facility
|
IP
|
$3,744.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
909301443
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,317.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.56
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Networks By Design Commercial |
$2,433.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
|
|
HC TANGNTL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
900511103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC TANGNTL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
900511103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC TANGNTL BX SKIN SINGLE LESION
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
900511102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$394.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC TANGNTL BX SKIN SINGLE LESION
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
900511102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC TAPE LEMAITRE GLOW N TELL
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
906812678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TAPE LEMAITRE GLOW N TELL
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
906812678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TARSORRHAPHY
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$927.80 |
| Max. Negotiated Rate |
$3,943.15 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,855.60
|
| Rate for Payer: Galaxy Health WC |
$3,943.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,783.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,094.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,767.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,871.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.36
|
| Rate for Payer: Multiplan Commercial |
$3,711.20
|
| Rate for Payer: Networks By Design Commercial |
$3,015.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,943.15
|
|
|
HC TARSORRHAPHY
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.06 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cigna of CA HMO |
$2,968.96
|
| Rate for Payer: Cigna of CA PPO |
$3,432.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$3,943.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,783.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,094.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$3,711.20
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,015.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,943.15
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,783.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,319.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,319.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,319.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,319.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC TAVI TAVR
|
Facility
|
OP
|
$140,080.00
|
|
| Hospital Charge Code |
906811453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$119,068.00 |
| Rate for Payer: Adventist Health Commercial |
$28,016.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119,068.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77,044.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105,060.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,023.13
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$63,036.00
|
| Rate for Payer: Cash Price |
$63,036.00
|
| Rate for Payer: Cigna of CA HMO |
$89,651.20
|
| Rate for Payer: Cigna of CA PPO |
$103,659.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119,068.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$119,068.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119,068.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56,032.00
|
| Rate for Payer: Galaxy Health WC |
$119,068.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84,048.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93,433.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53,370.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86,709.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33,619.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98,056.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98,056.00
|
| Rate for Payer: Multiplan Commercial |
$112,064.00
|
| Rate for Payer: Networks By Design Commercial |
$91,052.00
|
| Rate for Payer: Prime Health Services Commercial |
$119,068.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84,048.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$70,040.00
|
| Rate for Payer: United Healthcare All Other HMO |
$70,040.00
|
| Rate for Payer: United Healthcare HMO Rider |
$70,040.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70,040.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119,068.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119,068.00
|
| Rate for Payer: Vantage Medical Group Senior |
$119,068.00
|
|
|
HC TAVI TAVR
|
Facility
|
IP
|
$140,080.00
|
|
| Hospital Charge Code |
906811453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28,016.00 |
| Max. Negotiated Rate |
$119,068.00 |
| Rate for Payer: Adventist Health Commercial |
$28,016.00
|
| Rate for Payer: Cash Price |
$63,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,032.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56,032.00
|
| Rate for Payer: Galaxy Health WC |
$119,068.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84,048.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93,433.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53,370.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86,709.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33,619.20
|
| Rate for Payer: Multiplan Commercial |
$112,064.00
|
| Rate for Payer: Networks By Design Commercial |
$91,052.00
|
| Rate for Payer: Prime Health Services Commercial |
$119,068.00
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$52,946.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,589.20 |
| Max. Negotiated Rate |
$45,004.10 |
| Rate for Payer: Adventist Health Commercial |
$10,589.20
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,178.40
|
| Rate for Payer: EPIC Health Plan Senior |
$21,178.40
|
| Rate for Payer: Galaxy Health WC |
$45,004.10
|
| Rate for Payer: Global Benefits Group Commercial |
$31,767.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,314.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,172.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,773.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,707.04
|
| Rate for Payer: Multiplan Commercial |
$42,356.80
|
| Rate for Payer: Networks By Design Commercial |
$34,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$45,004.10
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
IP
|
$59,176.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906820334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,835.20 |
| Max. Negotiated Rate |
$50,299.60 |
| Rate for Payer: Adventist Health Commercial |
$11,835.20
|
| Rate for Payer: Cash Price |
$26,629.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,670.40
|
| Rate for Payer: EPIC Health Plan Senior |
$23,670.40
|
| Rate for Payer: Galaxy Health WC |
$50,299.60
|
| Rate for Payer: Global Benefits Group Commercial |
$35,505.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,470.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,546.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,629.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,202.24
|
| Rate for Payer: Multiplan Commercial |
$47,340.80
|
| Rate for Payer: Networks By Design Commercial |
$38,464.40
|
| Rate for Payer: Prime Health Services Commercial |
$50,299.60
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$52,946.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906813416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$45,004.10 |
| Rate for Payer: Adventist Health Commercial |
$10,589.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,514.14
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: Cash Price |
$23,825.70
|
| Rate for Payer: Cigna of CA HMO |
$33,885.44
|
| Rate for Payer: Cigna of CA PPO |
$39,180.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$45,004.10
|
| Rate for Payer: Global Benefits Group Commercial |
$31,767.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,314.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,707.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$42,356.80
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$34,414.90
|
| Rate for Payer: Prime Health Services Commercial |
$45,004.10
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,767.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC TAVR W PROS VALVE CAROTID
|
Facility
|
OP
|
$59,176.00
|
|
|
Service Code
|
CPT 33999
|
| Hospital Charge Code |
906820334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$50,299.60 |
| Rate for Payer: Adventist Health Commercial |
$11,835.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,339.98
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$26,629.20
|
| Rate for Payer: Cash Price |
$26,629.20
|
| Rate for Payer: Cash Price |
$26,629.20
|
| Rate for Payer: Cigna of CA HMO |
$37,872.64
|
| Rate for Payer: Cigna of CA PPO |
$43,790.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$50,299.60
|
| Rate for Payer: Global Benefits Group Commercial |
$35,505.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,470.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,202.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$47,340.80
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$38,464.40
|
| Rate for Payer: Prime Health Services Commercial |
$50,299.60
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,505.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
