|
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: 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: 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 |
$16.21
|
| Rate for Payer: Cash Price |
$11.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.90
|
| 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 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 |
$11.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.68
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.90
|
| 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 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 |
$176.40
|
| Rate for Payer: Cash Price |
$123.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.42
|
| 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 Foundation Hospitals Commercial/Self Funded |
$174.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.19
|
| 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 |
$123.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.42
|
| 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 Foundation Hospitals Commercial/Self Funded |
$174.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.19
|
| 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 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 |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$294.06
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| Rate for Payer: Cash Price |
$261.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$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 |
901605980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| 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 |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$294.06
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| Rate for Payer: Cash Price |
$261.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| 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 VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$18,711.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,622.68 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,742.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$8,419.95
|
| Rate for Payer: Cash Price |
$8,419.95
|
| Rate for Payer: Cash Price |
$8,419.95
|
| Rate for Payer: Cigna of CA HMO |
$12,162.15
|
| Rate for Payer: Cigna of CA PPO |
$13,846.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,097.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| Rate for Payer: Galaxy Health WC |
$15,904.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,226.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,622.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,881.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,835.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,490.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,223.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$14,968.80
|
| Rate for Payer: Networks By Design Commercial |
$12,162.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,904.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,226.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,226.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,355.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$18,711.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,742.20 |
| Max. Negotiated Rate |
$15,904.35 |
| Rate for Payer: Adventist Health Commercial |
$3,742.20
|
| Rate for Payer: Cash Price |
$8,419.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,097.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,484.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,484.40
|
| Rate for Payer: Galaxy Health WC |
$15,904.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,226.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,881.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,039.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,490.64
|
| Rate for Payer: Multiplan Commercial |
$14,968.80
|
| Rate for Payer: Networks By Design Commercial |
$12,162.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,904.35
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$12,474.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$350.73 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,494.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$5,613.30
|
| Rate for Payer: Cash Price |
$5,613.30
|
| Rate for Payer: Cash Price |
$5,613.30
|
| Rate for Payer: Cigna of CA HMO |
$8,108.10
|
| Rate for Payer: Cigna of CA PPO |
$9,230.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,731.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$10,602.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,484.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,920.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,993.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$9,979.20
|
| Rate for Payer: Networks By Design Commercial |
$8,108.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,602.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,484.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,484.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$12,474.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,494.80 |
| Max. Negotiated Rate |
$10,602.90 |
| Rate for Payer: Adventist Health Commercial |
$2,494.80
|
| Rate for Payer: Cash Price |
$5,613.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,731.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,989.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,989.60
|
| Rate for Payer: Galaxy Health WC |
$10,602.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,484.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,920.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,359.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,993.76
|
| Rate for Payer: Multiplan Commercial |
$9,979.20
|
| Rate for Payer: Networks By Design Commercial |
$8,108.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,602.90
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$13,788.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,757.60 |
| Max. Negotiated Rate |
$11,719.80 |
| Rate for Payer: Adventist Health Commercial |
$2,757.60
|
| Rate for Payer: Cash Price |
$6,204.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,651.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,515.20
|
| Rate for Payer: Galaxy Health WC |
$11,719.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,272.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,755.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,134.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,309.12
|
| Rate for Payer: Multiplan Commercial |
$11,030.40
|
| Rate for Payer: Networks By Design Commercial |
$8,962.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,719.80
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$13,788.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.95 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,757.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$6,204.60
|
| Rate for Payer: Cash Price |
$6,204.60
|
| Rate for Payer: Cash Price |
$6,204.60
|
| Rate for Payer: Cigna of CA HMO |
$8,962.20
|
| Rate for Payer: Cigna of CA PPO |
$10,203.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,651.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$11,719.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,272.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,375.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,755.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,556.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,309.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$11,030.40
|
| Rate for Payer: Networks By Design Commercial |
$8,962.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,719.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,272.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,272.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,894.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC VANCOMYCIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC VANCOMYCIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| 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 Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.81
|
| Rate for Payer: Blue Shield of California Commercial |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$112.94
|
| Rate for Payer: Blue Shield of California Commercial |
$35.55
|
| Rate for Payer: Blue Shield of California Commercial |
$170.76
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.23
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| 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 All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| 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 Commercial/Exchange |
$20.31
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| 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 Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.81
|
| Rate for Payer: Blue Shield of California Commercial |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$112.94
|
| Rate for Payer: Blue Shield of California Commercial |
$35.55
|
| Rate for Payer: Blue Shield of California Commercial |
$170.76
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.34
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.23
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| 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 All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| 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 Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$160.03 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.03
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$16.60
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.57
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: EPIC Health Plan Senior |
$17.05
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.96
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$385.90 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.81
|
| Rate for Payer: Blue Shield of California Commercial |
$230.18
|
| Rate for Payer: Blue Shield of California Commercial |
$349.13
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$385.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$12.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,296.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$372.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC VARICELLA ADMINISTRATION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
902890228
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
