|
HC SYSTEM NASAL TUBE RTNR 12-14FR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698433
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 SYSTEM NASAL TUBE RTNR 12-14FR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698433
|
|
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 |
$372.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 SYSTEM NASAL TUBE RTNR 16-18FR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698599
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 SYSTEM NASAL TUBE RTNR 16-18FR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698599
|
|
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 |
$372.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| 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 SYSTEM NASAL TUBE RTNR 8-10FR
|
Facility
|
IP
|
$613.18
|
|
| Hospital Charge Code |
901698432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Cash Price |
$275.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.27
|
| Rate for Payer: EPIC Health Plan Senior |
$245.27
|
| Rate for Payer: Galaxy Health WC |
$521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.16
|
| Rate for Payer: Multiplan Commercial |
$490.54
|
| Rate for Payer: Networks By Design Commercial |
$398.57
|
| Rate for Payer: Prime Health Services Commercial |
$521.20
|
|
|
HC SYSTEM NASAL TUBE RTNR 8-10FR
|
Facility
|
OP
|
$613.18
|
|
| Hospital Charge Code |
901698432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$521.20 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$402.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$521.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$459.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$393.48
|
| Rate for Payer: Cash Price |
$275.93
|
| Rate for Payer: Cigna of CA HMO |
$392.44
|
| Rate for Payer: Cigna of CA PPO |
$453.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$521.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$521.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$521.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.27
|
| Rate for Payer: EPIC Health Plan Senior |
$245.27
|
| Rate for Payer: Galaxy Health WC |
$521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$429.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$429.23
|
| Rate for Payer: Multiplan Commercial |
$490.54
|
| Rate for Payer: Networks By Design Commercial |
$398.57
|
| Rate for Payer: Prime Health Services Commercial |
$521.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$306.59
|
| Rate for Payer: United Healthcare All Other HMO |
$306.59
|
| Rate for Payer: United Healthcare HMO Rider |
$306.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$306.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$521.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$521.20
|
| Rate for Payer: Vantage Medical Group Senior |
$521.20
|
|
|
HC SYTM TORTLEAIR HEAD REPOSITIONING LRG 41-46CM
|
Facility
|
IP
|
$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: Cash Price |
$79.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$112.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.42
|
| 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
|
|
|
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 |
$113.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$112.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.28
|
| 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
|
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 |
$117.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$116.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.41
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$116.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.41
|
| 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 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 |
$117.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$116.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.41
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$116.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.41
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,620.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,377.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,208.96
|
| 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 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 |
$2,402.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,576.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,388.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,620.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,377.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,359.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,208.96
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| 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 |
$160.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$446.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$405.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$376.42
|
| 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 |
$32,312.00 |
| 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: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$405.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$319.00
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,247.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,945.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,737.01
|
| 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 |
$8,240.00 |
| Rate for Payer: United Healthcare HMO Rider |
$2,319.50
|
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,247.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| 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/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,945.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,113.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,852.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.51
|
| 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 Select/Navigate/Core |
$2,319.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$98,056.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$88,950.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,647.20
|
| 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 TAVI TAVR
|
Facility
|
OP
|
$140,080.00
|
|
| Hospital Charge Code |
906811453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,753.44 |
| 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 |
$89,889.34
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$98,056.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$88,950.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50,849.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,647.20
|
| 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 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 |
$806.82 |
| 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 |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,975.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,062.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33,620.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,707.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$26,473.00
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,062.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33,620.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,238.14
|
| 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 OPN AXLRY
|
Facility
|
IP
|
$53,762.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,752.40 |
| Max. Negotiated Rate |
$45,697.70 |
| Rate for Payer: Adventist Health Commercial |
$10,752.40
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,633.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,504.80
|
| Rate for Payer: EPIC Health Plan Senior |
$21,504.80
|
| Rate for Payer: Galaxy Health WC |
$45,697.70
|
| Rate for Payer: Global Benefits Group Commercial |
$32,257.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,138.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,719.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,902.88
|
| Rate for Payer: Multiplan Commercial |
$43,009.60
|
| Rate for Payer: Networks By Design Commercial |
$34,945.30
|
| Rate for Payer: Prime Health Services Commercial |
$45,697.70
|
|
