|
HC AMNIOTIC FLUID SCA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
900910277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC AMNIOTIC FLUID SCA
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
900910277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.95
|
| Rate for Payer: Blue Shield of California Commercial |
$13.37
|
| Rate for Payer: Blue Shield of California Commercial |
$129.08
|
| Rate for Payer: Blue Shield of California Commercial |
$20.21
|
| Rate for Payer: Blue Shield of California Commercial |
$195.16
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.43
|
| Rate for Payer: EPIC Health Plan Senior |
$10.29
|
| Rate for Payer: EPIC Health Plan Senior |
$10.29
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
OP
|
$9,509.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$8,082.65 |
| Rate for Payer: Adventist Health Commercial |
$3,898.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,171.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Cigna of CA HMO |
$6,085.76
|
| Rate for Payer: Cigna of CA PPO |
$7,036.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,656.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$8,082.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,705.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,282.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$7,607.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,180.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,082.65
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,705.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,705.40
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
OP
|
$9,509.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$8,082.65 |
| Rate for Payer: Adventist Health Commercial |
$1,901.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Cigna of CA HMO |
$6,085.76
|
| Rate for Payer: Cigna of CA PPO |
$7,036.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,656.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$8,082.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,705.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,282.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$7,607.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,180.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,082.65
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,705.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,754.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,754.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,754.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,754.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
IP
|
$9,509.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,901.80 |
| Max. Negotiated Rate |
$8,082.65 |
| Rate for Payer: Adventist Health Commercial |
$1,901.80
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,656.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,803.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,803.60
|
| Rate for Payer: Galaxy Health WC |
$8,082.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,705.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,610.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,282.16
|
| Rate for Payer: Multiplan Commercial |
$7,607.20
|
| Rate for Payer: Networks By Design Commercial |
$6,180.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,082.65
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
IP
|
$9,509.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,901.80 |
| Max. Negotiated Rate |
$8,082.65 |
| Rate for Payer: Adventist Health Commercial |
$1,901.80
|
| Rate for Payer: Cash Price |
$4,279.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,656.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,803.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,803.60
|
| Rate for Payer: Galaxy Health WC |
$8,082.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,705.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,610.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,282.16
|
| Rate for Payer: Multiplan Commercial |
$7,607.20
|
| Rate for Payer: Networks By Design Commercial |
$6,180.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,082.65
|
|
|
HC AMPHETAMINES CONF & ID
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900910520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.92
|
| Rate for Payer: Blue Shield of California Commercial |
$250.22
|
| Rate for Payer: Blue Shield of California Commercial |
$137.38
|
| Rate for Payer: Blue Shield of California Commercial |
$207.71
|
| Rate for Payer: Blue Shield of California Commercial |
$165.50
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA HMO |
$229.76
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Cigna of CA PPO |
$265.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$251.30
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
|
HC AMPHETAMINES CONF & ID
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900910520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.16
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
|
|
HC AMPICILLIN E TEST
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912448
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.28
|
| Rate for Payer: Blue Shield of California Commercial |
$39.19
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California Commercial |
$59.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC AMPICILLIN E TEST
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912448
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC AMPLATZER PLUG
|
Facility
|
IP
|
$3,120.00
|
|
| Hospital Charge Code |
909020031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO |
$2,184.00
|
| Rate for Payer: Cigna of CA PPO |
$2,184.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,981.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,840.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,170.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1,139.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,021.80
|
|
|
HC AMPLATZER PLUG
|
Facility
|
OP
|
$3,120.00
|
|
| Hospital Charge Code |
909020031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,716.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,888.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,581.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,399.28
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO |
$2,184.00
|
| Rate for Payer: Cigna of CA PPO |
$2,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,652.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,652.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,981.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,132.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,840.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,184.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Networks By Design Commercial |
$1,560.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,872.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,170.94
|
| Rate for Payer: United Healthcare All Other HMO |
$1,139.74
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,021.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,652.00
|
|
|
HC AMPLATZ MICRO SNARE
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$2,857.84 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,857.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,039.55
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.80
|
| Rate for Payer: Cigna of CA PPO |
$1,198.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC AMPLATZ MICRO SNARE
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,296.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
|
|
HC AMPLATZ RENAL DILATOR SET
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$371.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Networks By Design Commercial |
$315.00
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.44
|
| Rate for Payer: United Healthcare All Other HMO |
$230.14
|
| Rate for Payer: United Healthcare HMO Rider |
$225.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.32
|
|
|
HC AMPLATZ RENAL DILATOR SET
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$346.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$472.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.34
|
| Rate for Payer: Blue Shield of California Commercial |
$319.41
|
| Rate for Payer: Blue Shield of California Commercial |
$484.47
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO |
$441.00
|
| Rate for Payer: Cigna of CA PPO |
$441.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$535.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$535.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$535.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$252.00
|
| Rate for Payer: Galaxy Health WC |
$535.50
|
| Rate for Payer: Global Benefits Group Commercial |
$378.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$228.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$371.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$441.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Networks By Design Commercial |
$315.00
|
| Rate for Payer: Prime Health Services Commercial |
$535.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.44
|
| Rate for Payer: United Healthcare All Other HMO |
$230.14
|
| Rate for Payer: United Healthcare HMO Rider |
$225.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$535.50
|
| Rate for Payer: Vantage Medical Group Senior |
$535.50
|
|
|
HC AMPLATZ SNARE
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC AMPLATZ SNARE
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$2,857.84 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,857.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$445.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.78
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$688.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$688.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$688.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$405.00
|
| Rate for Payer: United Healthcare HMO Rider |
$405.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$405.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$688.50
|
| Rate for Payer: Vantage Medical Group Senior |
$688.50
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna of CA HMO |
$1,512.00
|
| Rate for Payer: Cigna of CA PPO |
$1,512.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,512.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Senior |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,371.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.40
|
| Rate for Payer: Multiplan Commercial |
$1,728.00
|
| Rate for Payer: Networks By Design Commercial |
$1,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.65
|
| Rate for Payer: United Healthcare All Other HMO |
$789.05
|
| Rate for Payer: United Healthcare HMO Rider |
$771.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$707.40
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,188.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,307.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,095.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,661.04
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna of CA HMO |
$1,512.00
|
| Rate for Payer: Cigna of CA PPO |
$1,512.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,836.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,836.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,512.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Senior |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,371.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$784.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,512.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,512.00
|
| Rate for Payer: Multiplan Commercial |
$1,728.00
|
| Rate for Payer: Networks By Design Commercial |
$1,080.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,296.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,296.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.65
|
| Rate for Payer: United Healthcare All Other HMO |
$789.05
|
| Rate for Payer: United Healthcare HMO Rider |
$771.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$707.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,836.00
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO |
$924.00
|
| Rate for Payer: Cigna of CA PPO |
$924.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.80
|
| Rate for Payer: Multiplan Commercial |
$1,056.00
|
| Rate for Payer: Networks By Design Commercial |
$660.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.40
|
| Rate for Payer: United Healthcare All Other HMO |
$482.20
|
| Rate for Payer: United Healthcare HMO Rider |
$471.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$432.30
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$726.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,015.08
|
| Rate for Payer: Blue Shield of California Commercial |
$669.24
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO |
$924.00
|
| Rate for Payer: Cigna of CA PPO |
$924.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,122.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,122.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$528.00
|
| Rate for Payer: Galaxy Health WC |
$1,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$792.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$479.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$924.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$924.00
|
| Rate for Payer: Multiplan Commercial |
$1,056.00
|
| Rate for Payer: Networks By Design Commercial |
$660.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.40
|
| Rate for Payer: United Healthcare All Other HMO |
$482.20
|
| Rate for Payer: United Healthcare HMO Rider |
$471.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$432.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,122.00
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.38
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$186.88
|
| Rate for Payer: Cigna of CA PPO |
$216.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$146.00
|
| Rate for Payer: United Healthcare All Other HMO |
$146.00
|
| Rate for Payer: United Healthcare HMO Rider |
$146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$554.40
|
| Rate for Payer: Cigna of CA PPO |
$554.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$396.00
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.24
|
| Rate for Payer: United Healthcare All Other HMO |
$289.32
|
| Rate for Payer: United Healthcare HMO Rider |
$283.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.38
|
|
