|
HC TTG IGA
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC TTG IGA
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGG
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TTG IGG
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913670
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$54.40 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.0FR
|
Facility
|
IP
|
$983.85
|
|
| Hospital Charge Code |
900800901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.0FR
|
Facility
|
OP
|
$983.85
|
|
| Hospital Charge Code |
900800901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.18
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.5FR
|
Facility
|
IP
|
$983.85
|
|
| Hospital Charge Code |
900800902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 3.5FR
|
Facility
|
OP
|
$983.85
|
|
| Hospital Charge Code |
900800902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.18
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 4.0FR
|
Facility
|
OP
|
$983.85
|
|
| Hospital Charge Code |
900800903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.18
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC TTS BIVNA NEO/PEDS FLXTD 4.0FR
|
Facility
|
IP
|
$983.85
|
|
| Hospital Charge Code |
900800903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC TTS BIVONA NEO CUFFED 3.0MM
|
Facility
|
OP
|
$843.41
|
|
| Hospital Charge Code |
900800909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.94
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 3.0MM
|
Facility
|
IP
|
$843.41
|
|
| Hospital Charge Code |
900800909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 3.5MM
|
Facility
|
OP
|
$843.41
|
|
| Hospital Charge Code |
900800908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.94
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 3.5MM
|
Facility
|
IP
|
$843.41
|
|
| Hospital Charge Code |
900800908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 4.0MM
|
Facility
|
OP
|
$843.41
|
|
| Hospital Charge Code |
900800907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.94
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA NEO CUFFED 4.0MM
|
Facility
|
IP
|
$843.41
|
|
| Hospital Charge Code |
900800907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 3.5MM
|
Facility
|
OP
|
$843.41
|
|
| Hospital Charge Code |
900800906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.94
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 3.5MM
|
Facility
|
IP
|
$843.41
|
|
| Hospital Charge Code |
900800906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.0MM
|
Facility
|
OP
|
$843.41
|
|
| Hospital Charge Code |
900800905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.94
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.0MM
|
Facility
|
IP
|
$843.41
|
|
| Hospital Charge Code |
900800905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.5MM
|
Facility
|
OP
|
$843.41
|
|
| Hospital Charge Code |
900800904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$632.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.94
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Cigna of CA HMO |
$539.78
|
| Rate for Payer: Cigna of CA PPO |
$624.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$716.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$716.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$716.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.39
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.70
|
| Rate for Payer: United Healthcare All Other HMO |
$421.70
|
| Rate for Payer: United Healthcare HMO Rider |
$421.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$421.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$716.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$716.90
|
| Rate for Payer: Vantage Medical Group Senior |
$716.90
|
|
|
HC TTS BIVONA PEDS CUFFED 4.5MM
|
Facility
|
IP
|
$843.41
|
|
| Hospital Charge Code |
900800904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$716.90 |
| Rate for Payer: Adventist Health Commercial |
$168.68
|
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.36
|
| Rate for Payer: EPIC Health Plan Senior |
$337.36
|
| Rate for Payer: Galaxy Health WC |
$716.90
|
| Rate for Payer: Global Benefits Group Commercial |
$506.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.42
|
| Rate for Payer: Multiplan Commercial |
$674.73
|
| Rate for Payer: Networks By Design Commercial |
$548.22
|
| Rate for Payer: Prime Health Services Commercial |
$716.90
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.40 |
| Max. Negotiated Rate |
$2,113.95 |
| Rate for Payer: Adventist Health Commercial |
$497.40
|
| Rate for Payer: Cash Price |
$1,119.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$994.80
|
| Rate for Payer: EPIC Health Plan Senior |
$994.80
|
| Rate for Payer: Galaxy Health WC |
$2,113.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,492.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,658.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,539.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.88
|
| Rate for Payer: Multiplan Commercial |
$1,989.60
|
| Rate for Payer: Networks By Design Commercial |
$1,616.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,113.95
|
|
|
HC T-TUBE CHOLANGIOGRAM INJ
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
909000191
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.40 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$497.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$1,119.15
|
| Rate for Payer: Cash Price |
$1,119.15
|
| Rate for Payer: Cash Price |
$1,119.15
|
| Rate for Payer: Cigna of CA HMO |
$1,591.68
|
| Rate for Payer: Cigna of CA PPO |
$1,840.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$2,113.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,492.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,658.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$1,989.60
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$1,616.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,113.95
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,492.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC TUBE BIVONA AIR CUFF PEDS
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900800708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
