|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$628.80
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,048.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$973.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC VAD DRSNG CHANGE KIT W/PVP
|
Facility
|
OP
|
$220.85
|
|
| Hospital Charge Code |
901698893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$187.72 |
| Rate for Payer: Adventist Health Commercial |
$44.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.62
|
| Rate for Payer: Cash Price |
$121.47
|
| Rate for Payer: Cigna of CA HMO |
$141.34
|
| Rate for Payer: Cigna of CA PPO |
$163.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: EPIC Health Plan Senior |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.59
|
| Rate for Payer: Multiplan Commercial |
$176.68
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.42
|
| Rate for Payer: United Healthcare All Other HMO |
$110.42
|
| Rate for Payer: United Healthcare HMO Rider |
$110.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.72
|
| Rate for Payer: Vantage Medical Group Senior |
$187.72
|
|
|
HC VAD DRSNG CHANGE KIT W/PVP
|
Facility
|
IP
|
$220.85
|
|
| Hospital Charge Code |
901698893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$187.72 |
| Rate for Payer: Adventist Health Commercial |
$44.17
|
| Rate for Payer: Cash Price |
$121.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: EPIC Health Plan Senior |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$176.68
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
OP
|
$4,672.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$11,413.00 |
| Rate for Payer: Adventist Health Commercial |
$934.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,064.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,971.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,569.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,504.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,413.00
|
| Rate for Payer: Cash Price |
$2,569.60
|
| Rate for Payer: Cash Price |
$2,569.60
|
| Rate for Payer: Cash Price |
$2,569.60
|
| Rate for Payer: Cigna of CA HMO |
$2,990.08
|
| Rate for Payer: Cigna of CA PPO |
$3,457.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,971.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,971.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,971.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,868.80
|
| Rate for Payer: Galaxy Health WC |
$3,971.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,803.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,513.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,116.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,973.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,891.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,270.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,270.40
|
| Rate for Payer: Multiplan Commercial |
$3,737.60
|
| Rate for Payer: Networks By Design Commercial |
$3,036.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,971.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,803.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,803.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,971.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,971.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,971.20
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
IP
|
$4,672.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$934.40 |
| Max. Negotiated Rate |
$3,971.20 |
| Rate for Payer: Adventist Health Commercial |
$934.40
|
| Rate for Payer: Cash Price |
$2,569.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,868.80
|
| Rate for Payer: Galaxy Health WC |
$3,971.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,803.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,116.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,780.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,891.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,121.28
|
| Rate for Payer: Multiplan Commercial |
$3,737.60
|
| Rate for Payer: Networks By Design Commercial |
$3,036.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,971.20
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$11,413.00 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,413.00
|
| Rate for Payer: Cash Price |
$2,048.75
|
| Rate for Payer: Cash Price |
$2,048.75
|
| Rate for Payer: Cash Price |
$2,048.75
|
| Rate for Payer: Cigna of CA HMO |
$2,384.00
|
| Rate for Payer: Cigna of CA PPO |
$2,756.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,484.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,034.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,235.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,862.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,862.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,862.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$3,166.25 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Cash Price |
$2,048.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,490.00
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,484.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,419.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,305.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
|
|
HC VAGINAL REPAIR
|
Facility
|
IP
|
$7,073.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
902400755
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,414.60 |
| Max. Negotiated Rate |
$6,012.05 |
| Rate for Payer: Adventist Health Commercial |
$1,414.60
|
| Rate for Payer: Cash Price |
$3,890.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,829.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,829.20
|
| Rate for Payer: Galaxy Health WC |
$6,012.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,243.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,717.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,694.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,378.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,697.52
|
| Rate for Payer: Multiplan Commercial |
$5,658.40
|
| Rate for Payer: Networks By Design Commercial |
$4,597.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,012.05
|
|
|
HC VAGINAL REPAIR
|
Facility
|
OP
|
$7,073.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
902400755
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$349.74 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,414.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,890.15
|
| Rate for Payer: Cash Price |
$3,890.15
|
| Rate for Payer: Cash Price |
$3,890.15
|
| Rate for Payer: Cigna of CA HMO |
$4,526.72
|
| Rate for Payer: Cigna of CA PPO |
$5,234.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,012.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,243.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$349.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,717.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,697.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$5,658.40
|
| Rate for Payer: Networks By Design Commercial |
$4,597.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,012.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,243.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,243.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.79
|
| Rate for Payer: Blue Shield of California Commercial |
$145.84
|
| Rate for Payer: Blue Shield of California EPN |
$96.36
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: EPIC Health Plan Senior |
$13.54
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC VALVE ANTI-REFLUXALE KIT
|
Facility
|
IP
|
$25.26
|
|
| Hospital Charge Code |
901605441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
|
|
HC VALVE ANTI-REFLUXALE KIT
|
Facility
|
OP
|
$25.26
|
|
| Hospital Charge Code |
901605441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.51
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: Cigna of CA HMO |
$16.17
|
| Rate for Payer: Cigna of CA PPO |
$18.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.68
|
| Rate for Payer: Multiplan Commercial |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.63
|
| Rate for Payer: United Healthcare All Other HMO |
$12.63
|
| Rate for Payer: United Healthcare HMO Rider |
$12.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: Vantage Medical Group Senior |
$21.47
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM
|
Facility
|
OP
|
$48,750.00
|
|
| Hospital Charge Code |
906812483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$41,437.50 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,236.00
|
| Rate for Payer: Blue Shield of California Commercial |
$35,977.50
|
| Rate for Payer: Blue Shield of California EPN |
$23,692.50
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,700.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,125.00
|
| Rate for Payer: Multiplan Commercial |
$39,000.00
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$41,437.50
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM
|
Facility
|
IP
|
$48,750.00
|
|
| Hospital Charge Code |
906812483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$41,437.50 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,700.00
|
| Rate for Payer: Multiplan Commercial |
$39,000.00
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM 3
|
Facility
|
IP
|
$48,750.00
|
|
| Hospital Charge Code |
906812561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$41,437.50 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,700.00
|
| Rate for Payer: Multiplan Commercial |
$39,000.00
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM 3
|
Facility
|
OP
|
$48,750.00
|
|
| Hospital Charge Code |
906812561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$41,437.50 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,236.00
|
| Rate for Payer: Blue Shield of California Commercial |
$35,977.50
|
| Rate for Payer: Blue Shield of California EPN |
$23,692.50
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,700.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,125.00
|
| Rate for Payer: Multiplan Commercial |
$39,000.00
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$41,437.50
|
|
|
HC VALVE HEIMLICH
|
Facility
|
OP
|
$274.89
|
|
| Hospital Charge Code |
901600145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$233.66 |
| Rate for Payer: Adventist Health Commercial |
$54.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$233.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$206.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.81
|
| Rate for Payer: Cash Price |
$151.19
|
| Rate for Payer: Cigna of CA HMO |
$175.93
|
| Rate for Payer: Cigna of CA PPO |
$203.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$233.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$233.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.96
|
| Rate for Payer: EPIC Health Plan Senior |
$109.96
|
| Rate for Payer: Galaxy Health WC |
$233.66
|
| Rate for Payer: Global Benefits Group Commercial |
$164.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.42
|
| Rate for Payer: Multiplan Commercial |
$219.91
|
| Rate for Payer: Networks By Design Commercial |
$178.68
|
| Rate for Payer: Prime Health Services Commercial |
$233.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.44
|
| Rate for Payer: United Healthcare All Other HMO |
$137.44
|
| Rate for Payer: United Healthcare HMO Rider |
$137.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$233.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$233.66
|
| Rate for Payer: Vantage Medical Group Senior |
$233.66
|
|
|
HC VALVE HEIMLICH
|
Facility
|
IP
|
$274.89
|
|
| Hospital Charge Code |
901600145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$233.66 |
| Rate for Payer: Adventist Health Commercial |
$54.98
|
| Rate for Payer: Cash Price |
$151.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.96
|
| Rate for Payer: EPIC Health Plan Senior |
$109.96
|
| Rate for Payer: Galaxy Health WC |
$233.66
|
| Rate for Payer: Global Benefits Group Commercial |
$164.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.97
|
| Rate for Payer: Multiplan Commercial |
$219.91
|
| Rate for Payer: Networks By Design Commercial |
$178.68
|
| Rate for Payer: Prime Health Services Commercial |
$233.66
|
|
|
HC VALVE MED MELODY PB10
|
Facility
|
OP
|
$36,000.00
|
|
| Hospital Charge Code |
906812446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$30,600.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,800.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,851.20
|
| Rate for Payer: Blue Shield of California Commercial |
$26,568.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,496.00
|
| Rate for Payer: Cash Price |
$19,800.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,600.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,716.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,640.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,200.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,200.00
|
| Rate for Payer: Multiplan Commercial |
$28,800.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Senior |
$30,600.00
|
|
|
HC VALVE MED MELODY PB10
|
Facility
|
IP
|
$36,000.00
|
|
| Hospital Charge Code |
906812446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$30,600.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$19,800.00
|
| Rate for Payer: Cash Price |
$19,800.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,716.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,640.00
|
| Rate for Payer: Multiplan Commercial |
$28,800.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
|
|
HC VALVE PASSY MUIR (PURPLE)
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
901603797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.94
|
| Rate for Payer: Blue Shield of California Commercial |
$428.04
|
| Rate for Payer: Blue Shield of California EPN |
$281.88
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC VALVE PASSY MUIR (PURPLE)
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
901603797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC VALVE PASSY MUIR (PURPLE)
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
901605980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC VALVE PASSY MUIR (PURPLE)
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
901605980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.94
|
| Rate for Payer: Blue Shield of California Commercial |
$428.04
|
| Rate for Payer: Blue Shield of California EPN |
$281.88
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
