|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$58,357.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906820332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,982.72 |
| Max. Negotiated Rate |
$49,603.45 |
| Rate for Payer: Adventist Health Commercial |
$11,671.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49,603.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,096.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43,767.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$32,096.35
|
| Rate for Payer: Cash Price |
$32,096.35
|
| Rate for Payer: Cash Price |
$32,096.35
|
| Rate for Payer: Cigna of CA HMO |
$37,348.48
|
| Rate for Payer: Cigna of CA PPO |
$43,184.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49,603.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$49,603.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49,603.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,342.80
|
| Rate for Payer: EPIC Health Plan Senior |
$23,342.80
|
| Rate for Payer: Galaxy Health WC |
$49,603.45
|
| Rate for Payer: Global Benefits Group Commercial |
$35,014.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,982.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38,924.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,242.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,122.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,005.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,849.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,849.90
|
| Rate for Payer: Multiplan Commercial |
$46,685.60
|
| Rate for Payer: Networks By Design Commercial |
$37,932.05
|
| Rate for Payer: Prime Health Services Commercial |
$49,603.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,014.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$49,603.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49,603.45
|
| Rate for Payer: Vantage Medical Group Senior |
$49,603.45
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
OP
|
$52,214.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,982.72 |
| Max. Negotiated Rate |
$44,381.90 |
| Rate for Payer: Adventist Health Commercial |
$10,442.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,381.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28,717.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,160.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$28,717.70
|
| Rate for Payer: Cash Price |
$28,717.70
|
| Rate for Payer: Cash Price |
$28,717.70
|
| Rate for Payer: Cigna of CA HMO |
$33,416.96
|
| Rate for Payer: Cigna of CA PPO |
$38,638.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,381.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,381.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,381.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,885.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20,885.60
|
| Rate for Payer: Galaxy Health WC |
$44,381.90
|
| Rate for Payer: Global Benefits Group Commercial |
$31,328.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,982.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,826.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,242.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,320.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,531.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,549.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,549.80
|
| Rate for Payer: Multiplan Commercial |
$41,771.20
|
| Rate for Payer: Networks By Design Commercial |
$33,939.10
|
| Rate for Payer: Prime Health Services Commercial |
$44,381.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,328.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$44,381.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,381.90
|
| Rate for Payer: Vantage Medical Group Senior |
$44,381.90
|
|
|
HC TAVR W PROS VALVE OPN FMRL
|
Facility
|
IP
|
$52,214.00
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
906813409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,442.80 |
| Max. Negotiated Rate |
$44,381.90 |
| Rate for Payer: Adventist Health Commercial |
$10,442.80
|
| Rate for Payer: Cash Price |
$28,717.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,885.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20,885.60
|
| Rate for Payer: Galaxy Health WC |
$44,381.90
|
| Rate for Payer: Global Benefits Group Commercial |
$31,328.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,826.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,893.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,320.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,531.36
|
| Rate for Payer: Multiplan Commercial |
$41,771.20
|
| Rate for Payer: Networks By Design Commercial |
$33,939.10
|
| Rate for Payer: Prime Health Services Commercial |
$44,381.90
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$60,500.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,187.88 |
| Max. Negotiated Rate |
$51,425.00 |
| Rate for Payer: Adventist Health Commercial |
$12,100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51,425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33,275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: Cigna of CA HMO |
$38,720.00
|
| Rate for Payer: Cigna of CA PPO |
$44,770.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51,425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51,425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51,425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24,200.00
|
| Rate for Payer: Galaxy Health WC |
$51,425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36,300.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,187.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,353.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,474.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,449.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,520.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,350.00
|
| Rate for Payer: Multiplan Commercial |
$48,400.00
|
| Rate for Payer: Networks By Design Commercial |
$39,325.00
|
| Rate for Payer: Prime Health Services Commercial |
$51,425.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,300.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$51,425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51,425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51,425.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$60,500.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,100.00 |
| Max. Negotiated Rate |
$51,425.00 |
| Rate for Payer: Adventist Health Commercial |
$12,100.00
|
| Rate for Payer: Cash Price |
$33,275.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24,200.00
|
| Rate for Payer: Galaxy Health WC |
$51,425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,353.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,050.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,449.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,520.00
|
| Rate for Payer: Multiplan Commercial |
$48,400.00
|
| Rate for Payer: Networks By Design Commercial |
$39,325.00
|
| Rate for Payer: Prime Health Services Commercial |
$51,425.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$54,131.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,826.20 |
| Max. Negotiated Rate |
$46,011.35 |
| Rate for Payer: Adventist Health Commercial |
$10,826.20
|
| Rate for Payer: Cash Price |
$29,772.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$21,652.40
|
| Rate for Payer: Galaxy Health WC |
$46,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32,478.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36,105.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,623.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,507.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,991.44
|
| Rate for Payer: Multiplan Commercial |
$43,304.80
|
| Rate for Payer: Networks By Design Commercial |
$35,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$46,011.35
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$54,131.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906813412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,187.88 |
| Max. Negotiated Rate |
$46,011.35 |
| Rate for Payer: Adventist Health Commercial |
$10,826.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46,011.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,772.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,598.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$29,772.05
|
| Rate for Payer: Cash Price |
$29,772.05
|
| Rate for Payer: Cash Price |
$29,772.05
|
| Rate for Payer: Cigna of CA HMO |
$34,643.84
|
| Rate for Payer: Cigna of CA PPO |
$40,056.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46,011.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$46,011.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46,011.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,652.40
|
| Rate for Payer: EPIC Health Plan Senior |
$21,652.40
|
| Rate for Payer: Galaxy Health WC |
$46,011.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32,478.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,187.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36,105.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,474.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,507.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,991.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,891.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,891.70
|
| Rate for Payer: Multiplan Commercial |
$43,304.80
|
| Rate for Payer: Networks By Design Commercial |
$35,185.15
|
| Rate for Payer: Prime Health Services Commercial |
$46,011.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,478.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$46,011.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46,011.35
|
| Rate for Payer: Vantage Medical Group Senior |
$46,011.35
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$53,954.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906820331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,790.80 |
| Max. Negotiated Rate |
$45,860.90 |
| Rate for Payer: Adventist Health Commercial |
$10,790.80
|
| Rate for Payer: Cash Price |
$29,674.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,581.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21,581.60
|
| Rate for Payer: Galaxy Health WC |
$45,860.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32,372.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,987.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,556.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,397.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,948.96
|
| Rate for Payer: Multiplan Commercial |
$43,163.20
|
| Rate for Payer: Networks By Design Commercial |
$35,070.10
|
| Rate for Payer: Prime Health Services Commercial |
$45,860.90
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$53,954.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906820331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$362.14 |
| Max. Negotiated Rate |
$45,860.90 |
| Rate for Payer: Adventist Health Commercial |
$10,790.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45,860.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,674.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,465.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$29,674.70
|
| Rate for Payer: Cash Price |
$29,674.70
|
| Rate for Payer: Cash Price |
$29,674.70
|
| Rate for Payer: Cigna of CA HMO |
$34,530.56
|
| Rate for Payer: Cigna of CA PPO |
$39,925.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45,860.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,860.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45,860.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,581.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21,581.60
|
| Rate for Payer: Galaxy Health WC |
$45,860.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32,372.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$362.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35,987.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,397.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,948.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,767.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,767.80
|
| Rate for Payer: Multiplan Commercial |
$43,163.20
|
| Rate for Payer: Networks By Design Commercial |
$35,070.10
|
| Rate for Payer: Prime Health Services Commercial |
$45,860.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,372.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$45,860.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,860.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45,860.90
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
IP
|
$48,275.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,655.00 |
| Max. Negotiated Rate |
$41,033.75 |
| Rate for Payer: Adventist Health Commercial |
$9,655.00
|
| Rate for Payer: Cash Price |
$26,551.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,310.00
|
| Rate for Payer: Galaxy Health WC |
$41,033.75
|
| Rate for Payer: Global Benefits Group Commercial |
$28,965.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,199.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,392.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,882.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,586.00
|
| Rate for Payer: Multiplan Commercial |
$38,620.00
|
| Rate for Payer: Networks By Design Commercial |
$31,378.75
|
| Rate for Payer: Prime Health Services Commercial |
$41,033.75
|
|
|
HC TAVR W PROS VALVE PERC FMRL
|
Facility
|
OP
|
$48,275.00
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
906813408
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$362.14 |
| Max. Negotiated Rate |
$41,033.75 |
| Rate for Payer: Adventist Health Commercial |
$9,655.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,033.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,551.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,206.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$26,551.25
|
| Rate for Payer: Cash Price |
$26,551.25
|
| Rate for Payer: Cash Price |
$26,551.25
|
| Rate for Payer: Cigna of CA HMO |
$30,896.00
|
| Rate for Payer: Cigna of CA PPO |
$35,723.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,033.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,033.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,033.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,310.00
|
| Rate for Payer: Galaxy Health WC |
$41,033.75
|
| Rate for Payer: Global Benefits Group Commercial |
$28,965.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$362.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,199.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,882.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,586.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,792.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,792.50
|
| Rate for Payer: Multiplan Commercial |
$38,620.00
|
| Rate for Payer: Networks By Design Commercial |
$31,378.75
|
| Rate for Payer: Prime Health Services Commercial |
$41,033.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,965.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$41,033.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,033.75
|
| Rate for Payer: Vantage Medical Group Senior |
$41,033.75
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$63,743.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906820340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$54,181.55 |
| Rate for Payer: Adventist Health Commercial |
$12,748.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,181.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35,058.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47,807.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: Cigna of CA HMO |
$40,795.52
|
| Rate for Payer: Cigna of CA PPO |
$47,169.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,181.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$54,181.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54,181.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,497.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25,497.20
|
| Rate for Payer: Galaxy Health WC |
$54,181.55
|
| Rate for Payer: Global Benefits Group Commercial |
$38,245.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$476.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42,516.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39,456.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,298.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44,620.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,620.10
|
| Rate for Payer: Multiplan Commercial |
$50,994.40
|
| Rate for Payer: Networks By Design Commercial |
$41,432.95
|
| Rate for Payer: Prime Health Services Commercial |
$54,181.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38,245.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$54,181.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54,181.55
|
| Rate for Payer: Vantage Medical Group Senior |
$54,181.55
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$63,743.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906820340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,748.60 |
| Max. Negotiated Rate |
$54,181.55 |
| Rate for Payer: Adventist Health Commercial |
$12,748.60
|
| Rate for Payer: Cash Price |
$35,058.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,497.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25,497.20
|
| Rate for Payer: Galaxy Health WC |
$54,181.55
|
| Rate for Payer: Global Benefits Group Commercial |
$38,245.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42,516.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,286.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39,456.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,298.32
|
| Rate for Payer: Multiplan Commercial |
$50,994.40
|
| Rate for Payer: Networks By Design Commercial |
$41,432.95
|
| Rate for Payer: Prime Health Services Commercial |
$54,181.55
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$57,033.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,406.60 |
| Max. Negotiated Rate |
$48,478.05 |
| Rate for Payer: Adventist Health Commercial |
$11,406.60
|
| Rate for Payer: Cash Price |
$31,368.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22,813.20
|
| Rate for Payer: Galaxy Health WC |
$48,478.05
|
| Rate for Payer: Global Benefits Group Commercial |
$34,219.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38,041.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,729.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,303.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,687.92
|
| Rate for Payer: Multiplan Commercial |
$45,626.40
|
| Rate for Payer: Networks By Design Commercial |
$37,071.45
|
| Rate for Payer: Prime Health Services Commercial |
$48,478.05
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$57,033.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906813413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$48,478.05 |
| Rate for Payer: Adventist Health Commercial |
$11,406.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,478.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,368.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,774.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$31,368.15
|
| Rate for Payer: Cash Price |
$31,368.15
|
| Rate for Payer: Cash Price |
$31,368.15
|
| Rate for Payer: Cigna of CA HMO |
$36,501.12
|
| Rate for Payer: Cigna of CA PPO |
$42,204.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,478.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,478.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48,478.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22,813.20
|
| Rate for Payer: Galaxy Health WC |
$48,478.05
|
| Rate for Payer: Global Benefits Group Commercial |
$34,219.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$476.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38,041.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,303.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,687.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,923.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,923.10
|
| Rate for Payer: Multiplan Commercial |
$45,626.40
|
| Rate for Payer: Networks By Design Commercial |
$37,071.45
|
| Rate for Payer: Prime Health Services Commercial |
$48,478.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,219.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$48,478.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,478.05
|
| Rate for Payer: Vantage Medical Group Senior |
$48,478.05
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
OP
|
$52,265.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$44,425.25 |
| Rate for Payer: Adventist Health Commercial |
$10,453.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44,425.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28,745.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39,198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$28,745.75
|
| Rate for Payer: Cash Price |
$28,745.75
|
| Rate for Payer: Cash Price |
$28,745.75
|
| Rate for Payer: Cigna of CA HMO |
$33,449.60
|
| Rate for Payer: Cigna of CA PPO |
$38,676.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44,425.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,425.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,425.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,906.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,906.00
|
| Rate for Payer: Galaxy Health WC |
$44,425.25
|
| Rate for Payer: Global Benefits Group Commercial |
$31,359.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,700.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,860.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,053.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,352.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,543.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,585.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,585.50
|
| Rate for Payer: Multiplan Commercial |
$41,812.00
|
| Rate for Payer: Networks By Design Commercial |
$33,972.25
|
| Rate for Payer: Prime Health Services Commercial |
$44,425.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31,359.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$44,425.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,425.25
|
| Rate for Payer: Vantage Medical Group Senior |
$44,425.25
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
OP
|
$58,414.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906820341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$49,651.90 |
| Rate for Payer: Adventist Health Commercial |
$11,682.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49,651.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,127.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43,810.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$32,127.70
|
| Rate for Payer: Cash Price |
$32,127.70
|
| Rate for Payer: Cash Price |
$32,127.70
|
| Rate for Payer: Cigna of CA HMO |
$37,384.96
|
| Rate for Payer: Cigna of CA PPO |
$43,226.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49,651.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$49,651.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49,651.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,365.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23,365.60
|
| Rate for Payer: Galaxy Health WC |
$49,651.90
|
| Rate for Payer: Global Benefits Group Commercial |
$35,048.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,700.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38,962.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,053.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,158.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,019.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,889.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,889.80
|
| Rate for Payer: Multiplan Commercial |
$46,731.20
|
| Rate for Payer: Networks By Design Commercial |
$37,969.10
|
| Rate for Payer: Prime Health Services Commercial |
$49,651.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,048.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$49,651.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49,651.90
|
| Rate for Payer: Vantage Medical Group Senior |
$49,651.90
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
IP
|
$52,265.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,453.00 |
| Max. Negotiated Rate |
$44,425.25 |
| Rate for Payer: Adventist Health Commercial |
$10,453.00
|
| Rate for Payer: Cash Price |
$28,745.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,906.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20,906.00
|
| Rate for Payer: Galaxy Health WC |
$44,425.25
|
| Rate for Payer: Global Benefits Group Commercial |
$31,359.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34,860.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,912.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,352.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,543.60
|
| Rate for Payer: Multiplan Commercial |
$41,812.00
|
| Rate for Payer: Networks By Design Commercial |
$33,972.25
|
| Rate for Payer: Prime Health Services Commercial |
$44,425.25
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
IP
|
$58,414.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906820341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,682.80 |
| Max. Negotiated Rate |
$49,651.90 |
| Rate for Payer: Adventist Health Commercial |
$11,682.80
|
| Rate for Payer: Cash Price |
$32,127.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,365.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23,365.60
|
| Rate for Payer: Galaxy Health WC |
$49,651.90
|
| Rate for Payer: Global Benefits Group Commercial |
$35,048.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38,962.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,255.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,158.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,019.36
|
| Rate for Payer: Multiplan Commercial |
$46,731.20
|
| Rate for Payer: Networks By Design Commercial |
$37,969.10
|
| Rate for Payer: Prime Health Services Commercial |
$49,651.90
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.29
|
| Rate for Payer: Blue Shield of California Commercial |
$52.85
|
| Rate for Payer: Blue Shield of California EPN |
$34.92
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
941000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.29
|
| Rate for Payer: Blue Shield of California Commercial |
$52.85
|
| Rate for Payer: Blue Shield of California EPN |
$34.92
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
941000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
IP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,076.40 |
| Max. Negotiated Rate |
$4,574.70 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,971.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,615.65
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.80
|
| Rate for Payer: Galaxy Health WC |
$4,574.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,229.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,589.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,050.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,331.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,291.68
|
| Rate for Payer: Multiplan Commercial |
$4,305.60
|
| Rate for Payer: Networks By Design Commercial |
$3,498.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,574.70
|
|
|
HC TC-99 ARCITUMOMAB/CEA TO 45MCI
|
Facility
|
OP
|
$5,382.00
|
|
|
Service Code
|
CPT A9568
|
| Hospital Charge Code |
909301539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$809.51 |
| Max. Negotiated Rate |
$4,574.70 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$890.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$890.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,305.09
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cigna of CA HMO |
$3,444.48
|
| Rate for Payer: Cigna of CA PPO |
$3,982.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.84
|
| Rate for Payer: EPIC Health Plan Senior |
$809.51
|
| Rate for Payer: Galaxy Health WC |
$4,574.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,229.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,327.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$809.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,589.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,050.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$809.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,291.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,019.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,084.74
|
| Rate for Payer: Multiplan Commercial |
$4,305.60
|
| Rate for Payer: Networks By Design Commercial |
$3,498.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,574.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,229.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,691.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,691.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$809.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.46
|
| Rate for Payer: Vantage Medical Group Senior |
$890.46
|
|
