|
HC TAVR W PROS VALVE OPN AXLRY
|
Facility
|
OP
|
$53,762.00
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
906813410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$410.93 |
| Max. Negotiated Rate |
$45,697.70 |
| Rate for Payer: Adventist Health Commercial |
$10,752.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45,697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29,569.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,321.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Cash Price |
$24,192.90
|
| Rate for Payer: Cigna of CA HMO |
$34,407.68
|
| Rate for Payer: Cigna of CA PPO |
$39,783.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45,697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,697.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45,697.70
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$410.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34,138.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$464.74
|
| 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: Molina Healthcare of CA Medi-Cal |
$37,633.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,633.40
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32,257.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,881.00
|
| 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 |
$45,697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,697.70
|
| Rate for Payer: Vantage Medical Group Senior |
$45,697.70
|
|
|
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 |
$23,496.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,549.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33,155.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,806.26
|
| 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 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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$23,496.30
|
| Rate for Payer: Cash Price |
$23,496.30
|
| Rate for Payer: Cash Price |
$23,496.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,549.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33,155.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,242.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,806.26
|
| 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 |
$26,107.00
|
| 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 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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$24,358.95
|
| Rate for Payer: Cash Price |
$24,358.95
|
| Rate for Payer: Cash Price |
$24,358.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,891.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34,373.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,474.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,937.29
|
| 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 |
$27,065.50
|
| 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 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 |
$24,358.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37,891.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34,373.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,937.29
|
| 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 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 |
$11,924.00
|
| 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 |
$21,723.75
|
| Rate for Payer: Cash Price |
$21,723.75
|
| Rate for Payer: Cash Price |
$21,723.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,792.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$30,654.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$409.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,482.25
|
| 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 |
$24,137.50
|
| 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 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 |
$21,723.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,792.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$30,654.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,482.25
|
| 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 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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$25,664.85
|
| Rate for Payer: Cash Price |
$25,664.85
|
| Rate for Payer: Cash Price |
$25,664.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,923.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$36,215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,649.47
|
| 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 |
$28,516.50
|
| 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 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 |
$25,664.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,923.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$36,215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,649.47
|
| 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 TRNSAPICAL
|
Facility
|
OP
|
$52,265.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906813415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.18 |
| 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 |
$11,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$23,519.25
|
| Rate for Payer: Cash Price |
$23,519.25
|
| Rate for Payer: Cash Price |
$23,519.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,585.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33,188.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,053.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,836.35
|
| 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 |
$26,132.50
|
| 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
|
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 |
$23,519.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36,585.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33,188.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,836.35
|
| 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 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 |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| 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
|
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 |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| 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
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| 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 |
900501583
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.69
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| 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 |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| 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 |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
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 |
$73.45 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.45
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California Commercial |
$55.06
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| 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 |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| 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 |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| 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 |
$73.45 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.45
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Blue Shield of California Commercial |
$55.06
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| 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 |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| 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 |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
900501583
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Multiplan WC |
$49.59
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Adventist Health Commercial |
$32.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| 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 |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Prime Health Services WC |
$49.08
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
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 |
$2,728.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4,138.76
|
| Rate for Payer: Cash Price |
$2,421.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,767.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,417.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,175.38
|
| 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 |
$1,076.40 |
| Max. Negotiated Rate |
$4,574.70 |
| Rate for Payer: Adventist Health Commercial |
$1,076.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,960.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,036.50
|
| Rate for Payer: Cash Price |
$2,421.90
|
| 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 |
$4,574.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,574.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,574.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,767.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,417.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,953.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,175.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,291.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,767.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,767.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$4,574.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,574.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,574.70
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.60 |
| Max. Negotiated Rate |
$1,439.05 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$905.39
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Cigna of CA HMO |
$1,185.10
|
| Rate for Payer: Cigna of CA PPO |
$1,185.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$853.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$853.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,185.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.61
|
| Rate for Payer: EPIC Health Plan Senior |
$853.07
|
| Rate for Payer: Galaxy Health WC |
$1,439.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,015.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,271.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$570.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$775.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,075.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,085.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$977.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,039.20
|
| Rate for Payer: Multiplan Commercial |
$1,354.40
|
| Rate for Payer: Networks By Design Commercial |
$846.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,015.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,015.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$635.38
|
| Rate for Payer: United Healthcare All Other HMO |
$618.45
|
| Rate for Payer: United Healthcare HMO Rider |
$605.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$775.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$853.07
|
| Rate for Payer: Vantage Medical Group Senior |
$853.07
|
|
|
HC TC-99 BICISTAE/NUEROLITE LT 25MCI
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT A9557
|
| Hospital Charge Code |
909301541
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.60 |
| Max. Negotiated Rate |
$1,439.05 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,301.92
|
| Rate for Payer: Blue Shield of California Commercial |
$858.35
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Cigna of CA HMO |
$1,185.10
|
| Rate for Payer: Cigna of CA PPO |
$1,185.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,185.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.20
|
| Rate for Payer: EPIC Health Plan Senior |
$677.20
|
| Rate for Payer: Galaxy Health WC |
$1,439.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,015.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,075.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$998.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.32
|
| Rate for Payer: Multiplan Commercial |
$1,354.40
|
| Rate for Payer: Networks By Design Commercial |
$846.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$635.38
|
| Rate for Payer: United Healthcare All Other HMO |
$618.45
|
| Rate for Payer: United Healthcare HMO Rider |
$605.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.46
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,660.50 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,347.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,995.97
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,660.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,660.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$762.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,191.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,191.00
|
| Rate for Payer: Multiplan Commercial |
$2,504.00
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
HC TC-99 CERETEC UP TO 25 MCI
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
909301535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,660.50 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,586.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,406.97
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.20
|
| Rate for Payer: Multiplan Commercial |
$2,504.00
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
|
