|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$486.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$342.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.57 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$480.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$358.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.50
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
915352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$496.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
905352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$664.70 |
| Rate for Payer: Adventist Health Commercial |
$320.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.34
|
| Rate for Payer: Blue Shield of California Commercial |
$601.36
|
| Rate for Payer: Blue Shield of California Commercial |
$396.47
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$664.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$363.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$496.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$410.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
905352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$496.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
915352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$664.70 |
| Rate for Payer: Adventist Health Commercial |
$320.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.34
|
| Rate for Payer: Blue Shield of California Commercial |
$601.36
|
| Rate for Payer: Blue Shield of California Commercial |
$396.47
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$664.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$363.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$496.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$410.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
905352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.28
|
| Rate for Payer: Blue Shield of California Commercial |
$330.67
|
| Rate for Payer: Blue Shield of California Commercial |
$218.01
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
915352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
905352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
915352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.28
|
| Rate for Payer: Blue Shield of California Commercial |
$330.67
|
| Rate for Payer: Blue Shield of California Commercial |
$218.01
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,211.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,652.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cigna of CA HMO |
$1,409.92
|
| Rate for Payer: Cigna of CA PPO |
$1,630.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,872.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,542.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,299.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,542.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,542.10
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,321.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,101.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,872.55
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$1,872.55 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,542.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,299.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.24 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cigna of CA HMO |
$2,321.92
|
| Rate for Payer: Cigna of CA PPO |
$2,684.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,539.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$335.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,303.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,814.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$3,083.80 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,539.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,451.20
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,303.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,140.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
IP
|
$14,889.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,977.80 |
| Max. Negotiated Rate |
$12,655.65 |
| Rate for Payer: Adventist Health Commercial |
$2,977.80
|
| Rate for Payer: Cash Price |
$6,700.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,422.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,955.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,955.60
|
| Rate for Payer: Galaxy Health WC |
$12,655.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,933.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,454.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,784.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,573.36
|
| Rate for Payer: Multiplan Commercial |
$11,911.20
|
| Rate for Payer: Networks By Design Commercial |
$9,677.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,655.65
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
OP
|
$14,889.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$930.69 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,977.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$6,700.05
|
| Rate for Payer: Cash Price |
$6,700.05
|
| Rate for Payer: Cash Price |
$6,700.05
|
| Rate for Payer: Cigna of CA HMO |
$9,528.96
|
| Rate for Payer: Cigna of CA PPO |
$11,017.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,422.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,829.67
|
| Rate for Payer: EPIC Health Plan Senior |
$8,553.12
|
| Rate for Payer: Galaxy Health WC |
$12,655.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,933.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,751.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$930.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,454.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,052.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,885.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,573.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,797.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,419.25
|
| Rate for Payer: Multiplan Commercial |
$11,911.20
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$9,677.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,655.65
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,933.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,444.50
|
| 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 |
$7,775.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$663.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$618.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$843.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cigna of CA HMO |
$731.25
|
| Rate for Payer: Cigna of CA PPO |
$832.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$956.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$956.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$956.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$663.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$956.25
|
| Rate for Payer: Vantage Medical Group Senior |
$956.25
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$16,380.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$554.06 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,276.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,923.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,009.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,285.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$7,371.00
|
| Rate for Payer: Cash Price |
$7,371.00
|
| Rate for Payer: Cash Price |
$7,371.00
|
| Rate for Payer: Cigna of CA HMO |
$10,647.00
|
| Rate for Payer: Cigna of CA PPO |
$12,121.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,923.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,923.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,923.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,552.00
|
| Rate for Payer: Galaxy Health WC |
$13,923.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,828.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$554.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,401.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,664.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,931.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,466.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,466.00
|
| Rate for Payer: Multiplan Commercial |
$13,104.00
|
| Rate for Payer: Networks By Design Commercial |
$10,647.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,923.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,828.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,828.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,190.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,923.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,923.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,923.00
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$16,380.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,276.00 |
| Max. Negotiated Rate |
$13,923.00 |
| Rate for Payer: Adventist Health Commercial |
$3,276.00
|
| Rate for Payer: Cash Price |
$7,371.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,552.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,552.00
|
| Rate for Payer: Galaxy Health WC |
$13,923.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,828.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,401.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,664.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,931.20
|
| Rate for Payer: Multiplan Commercial |
$13,104.00
|
| Rate for Payer: Networks By Design Commercial |
$10,647.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,923.00
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.77
|
| 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 |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$364.80
|
| Rate for Payer: Cigna of CA PPO |
$421.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$444.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$3,083.80 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,539.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,451.20
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,303.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,140.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
|
