|
HC VENOUS PORT EXCHANGE
|
Facility
|
OP
|
$10,415.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$806.82 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cigna of CA HMO |
$6,665.60
|
| Rate for Payer: Adventist Health Commercial |
$2,083.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,683.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cash Price |
$4,686.75
|
| Rate for Payer: Cigna of CA PPO |
$7,707.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$8,852.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,613.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,499.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$8,332.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$6,769.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,852.75
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,207.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC VENOUS SAMPLING
|
Facility
|
IP
|
$10,028.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,005.60 |
| Max. Negotiated Rate |
$8,523.80 |
| Rate for Payer: Adventist Health Commercial |
$2,005.60
|
| Rate for Payer: Cash Price |
$4,512.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,019.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,011.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,011.20
|
| Rate for Payer: Galaxy Health WC |
$8,523.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,016.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,367.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,916.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,406.72
|
| Rate for Payer: Multiplan Commercial |
$8,022.40
|
| Rate for Payer: Networks By Design Commercial |
$6,518.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,523.80
|
|
|
HC VENOUS SAMPLING
|
Facility
|
OP
|
$10,028.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,098.80 |
| Max. Negotiated Rate |
$11,808.82 |
| Rate for Payer: Adventist Health Commercial |
$2,005.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,098.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,700.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,221.79
|
| Rate for Payer: Blue Shield of California Commercial |
$6,397.86
|
| Rate for Payer: Cash Price |
$4,512.60
|
| Rate for Payer: Cash Price |
$4,512.60
|
| Rate for Payer: Cigna of CA HMO |
$6,417.92
|
| Rate for Payer: Cigna of CA PPO |
$7,420.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,019.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$8,523.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,016.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,367.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,406.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$8,022.40
|
| Rate for Payer: Networks By Design Commercial |
$6,518.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,523.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,016.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,016.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.20 |
| Max. Negotiated Rate |
$1,093.10 |
| Rate for Payer: Adventist Health Commercial |
$257.20
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$900.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.40
|
| Rate for Payer: EPIC Health Plan Senior |
$514.40
|
| Rate for Payer: Galaxy Health WC |
$1,093.10
|
| Rate for Payer: Global Benefits Group Commercial |
$771.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$816.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$758.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.64
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: Networks By Design Commercial |
$835.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,093.10
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$1,104.15 |
| Rate for Payer: Adventist Health Commercial |
$257.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,104.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$825.23
|
| Rate for Payer: Blue Shield of California Commercial |
$820.47
|
| Rate for Payer: Blue Shield of California Commercial |
$541.41
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cigna of CA HMO |
$823.04
|
| Rate for Payer: Cigna of CA PPO |
$951.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$900.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,093.10
|
| Rate for Payer: Global Benefits Group Commercial |
$771.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$816.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: Networks By Design Commercial |
$835.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,093.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$771.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$771.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.46
|
| Rate for Payer: United Healthcare All Other HMO |
$396.46
|
| Rate for Payer: United Healthcare HMO Rider |
$396.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$116.34 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,918.04
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS AT ABOVE HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93587
|
| Hospital Charge Code |
906811587
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,540.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,540.65 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
|
|
HC VENOVENOUS COLLATERALS BELOW HEART
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 93588
|
| Hospital Charge Code |
906811588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$117.26 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$597.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,643.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,241.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,918.04
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cash Price |
$1,345.05
|
| Rate for Payer: Cigna of CA HMO |
$1,942.85
|
| Rate for Payer: Cigna of CA PPO |
$2,211.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,540.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,540.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,092.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,195.60
|
| Rate for Payer: Galaxy Health WC |
$2,540.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,793.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,763.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,092.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,092.30
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Networks By Design Commercial |
$1,942.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,540.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,793.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,793.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,494.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,494.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,540.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,540.65
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
IP
|
$11,830.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,366.00 |
| Max. Negotiated Rate |
$10,055.50 |
| Rate for Payer: EPIC Health Plan Senior |
$4,732.00
|
| Rate for Payer: Galaxy Health WC |
$10,055.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,732.00
|
| Rate for Payer: Adventist Health Commercial |
$2,366.00
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,281.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,098.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,512.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,979.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,839.20
|
| Rate for Payer: Multiplan Commercial |
$9,464.00
|
| Rate for Payer: Networks By Design Commercial |
$7,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,055.50
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
OP
|
$11,830.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.26 |
| Max. Negotiated Rate |
$10,055.50 |
| Rate for Payer: Adventist Health Commercial |
$2,366.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$578.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cigna of CA HMO |
$7,571.20
|
| Rate for Payer: Cigna of CA PPO |
$8,754.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,281.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| Rate for Payer: Galaxy Health WC |
$10,055.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,098.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,512.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,839.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$9,464.00
|
| Rate for Payer: Networks By Design Commercial |
$7,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,055.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,098.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,098.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
IP
|
$8,190.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$6,961.50 |
| Rate for Payer: Adventist Health Commercial |
$1,638.00
|
| Rate for Payer: Cash Price |
$3,685.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,733.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,276.00
|
| Rate for Payer: Galaxy Health WC |
$6,961.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,914.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,200.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,832.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$6,552.00
|
| Rate for Payer: Networks By Design Commercial |
$5,323.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,961.50
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
OP
|
$8,190.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$6,961.50 |
| Rate for Payer: Adventist Health Commercial |
$1,638.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$3,685.50
|
| Rate for Payer: Cash Price |
$3,685.50
|
| Rate for Payer: Cash Price |
$3,685.50
|
| Rate for Payer: Cash Price |
$3,685.50
|
| Rate for Payer: Cigna of CA HMO |
$5,241.60
|
| Rate for Payer: Cigna of CA PPO |
$6,060.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,733.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| Rate for Payer: Galaxy Health WC |
$6,961.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,914.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,200.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,965.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,064.74
|
| Rate for Payer: Multiplan Commercial |
$6,552.00
|
| Rate for Payer: Networks By Design Commercial |
$5,323.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,961.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,914.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,914.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.40 |
| Max. Negotiated Rate |
$2,288.20 |
| Rate for Payer: Adventist Health Commercial |
$538.40
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,884.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,076.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,076.80
|
| Rate for Payer: Galaxy Health WC |
$2,288.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,709.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.08
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: Networks By Design Commercial |
$1,749.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,288.20
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,103.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$872.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Cigna of CA HMO |
$1,722.88
|
| Rate for Payer: Cigna of CA PPO |
$1,992.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,884.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,288.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,709.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,749.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,288.20
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$538.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Cigna of CA HMO |
$1,722.88
|
| Rate for Payer: Cigna of CA PPO |
$1,992.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,884.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,288.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,709.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,749.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,288.20
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,346.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,346.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,346.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,346.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$538.40 |
| Max. Negotiated Rate |
$2,288.20 |
| Rate for Payer: Adventist Health Commercial |
$538.40
|
| Rate for Payer: Cash Price |
$1,211.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,884.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,076.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,076.80
|
| Rate for Payer: Galaxy Health WC |
$2,288.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,709.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.08
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: Networks By Design Commercial |
$1,749.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,288.20
|
|
|
HC VENT TUBE
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.51
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC VENT TUBE
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna of CA HMO |
$1,000.96
|
| Rate for Payer: Cigna of CA PPO |
$1,157.36
|
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$851.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,003.62
|
| Rate for Payer: Blue Shield of California Commercial |
$658.44
|
| Rate for Payer: Blue Shield of California Commercial |
$997.83
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$938.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$938.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,329.40 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.36
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$15,296.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.85 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,059.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$6,883.20
|
| Rate for Payer: Cash Price |
$6,883.20
|
| Rate for Payer: Cash Price |
$6,883.20
|
| Rate for Payer: Cigna of CA HMO |
$9,789.44
|
| Rate for Payer: Cigna of CA PPO |
$11,319.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,707.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$13,001.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,177.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$472.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,712.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,671.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,017.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$12,236.80
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$9,942.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,001.60
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,648.00
|
| 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 |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC VERTEBRAL UNI
|
Facility
|
IP
|
$15,296.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,059.20 |
| Max. Negotiated Rate |
$13,001.60 |
| Rate for Payer: Adventist Health Commercial |
$3,059.20
|
| Rate for Payer: Cash Price |
$6,883.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,707.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,118.40
|
| Rate for Payer: Galaxy Health WC |
$13,001.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,177.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,712.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,024.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,671.04
|
| Rate for Payer: Multiplan Commercial |
$12,236.80
|
| Rate for Payer: Networks By Design Commercial |
$9,942.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,001.60
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$1,099.90 |
| Rate for Payer: Adventist Health Commercial |
$258.80
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$905.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$517.60
|
| Rate for Payer: EPIC Health Plan Senior |
$517.60
|
| Rate for Payer: Galaxy Health WC |
$1,099.90
|
| Rate for Payer: Global Benefits Group Commercial |
$776.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$821.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$763.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.56
|
| Rate for Payer: Multiplan Commercial |
$1,035.20
|
| Rate for Payer: Networks By Design Commercial |
$841.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.90
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.83 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
| Rate for Payer: Adventist Health Commercial |
$258.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Cigna of CA HMO |
$828.16
|
| Rate for Payer: Cigna of CA PPO |
$957.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$905.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$1,099.90
|
| Rate for Payer: Global Benefits Group Commercial |
$776.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$821.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,035.20
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$841.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.90
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$776.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.00
|
| Rate for Payer: United Healthcare All Other HMO |
$647.00
|
| Rate for Payer: United Healthcare HMO Rider |
$647.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$647.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
|
