|
HC BAL BS EMERGE NC
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$322.00
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.69
|
| Rate for Payer: United Healthcare All Other HMO |
$235.25
|
| Rate for Payer: United Healthcare HMO Rider |
$230.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.91
|
|
|
HC BAL BS EMERGE NC
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$547.40 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.00
|
| Rate for Payer: Blue Shield of California Commercial |
$475.27
|
| Rate for Payer: Blue Shield of California EPN |
$312.98
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Networks By Design Commercial |
$322.00
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.69
|
| Rate for Payer: United Healthcare All Other HMO |
$235.25
|
| Rate for Payer: United Healthcare HMO Rider |
$230.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC BAL B/S QUANTUM APEX
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$482.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$404.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.98
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$471.04
|
| Rate for Payer: Cigna of CA PPO |
$544.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$625.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$294.40
|
| Rate for Payer: Galaxy Health WC |
$625.60
|
| Rate for Payer: Global Benefits Group Commercial |
$441.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Networks By Design Commercial |
$478.40
|
| Rate for Payer: Prime Health Services Commercial |
$625.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$441.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$441.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$368.00
|
| Rate for Payer: United Healthcare All Other HMO |
$368.00
|
| Rate for Payer: United Healthcare HMO Rider |
$368.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$625.60
|
| Rate for Payer: Vantage Medical Group Senior |
$625.60
|
|
|
HC BAL B/S QUANTUM APEX
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$294.40
|
| Rate for Payer: Galaxy Health WC |
$625.60
|
| Rate for Payer: Global Benefits Group Commercial |
$441.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$455.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Networks By Design Commercial |
$478.40
|
| Rate for Payer: Prime Health Services Commercial |
$625.60
|
|
|
HC BAL B/S WOLVERINE
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812741
|
|
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 |
$1,807.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,302.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,516.32
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| 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 BAL B/S WOLVERINE
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| 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 BAL COOK CODA
|
Facility
|
IP
|
$1,918.20
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
906812514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.64 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$383.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$863.19
|
| Rate for Payer: Cash Price |
$863.19
|
| Rate for Payer: Cigna of CA HMO |
$1,342.74
|
| Rate for Payer: Cigna of CA PPO |
$1,342.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$767.28
|
| Rate for Payer: EPIC Health Plan Senior |
$767.28
|
| Rate for Payer: Galaxy Health WC |
$1,630.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1,150.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,279.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,187.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.37
|
| Rate for Payer: Multiplan Commercial |
$1,534.56
|
| Rate for Payer: Networks By Design Commercial |
$959.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,630.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$719.90
|
| Rate for Payer: United Healthcare All Other HMO |
$700.72
|
| Rate for Payer: United Healthcare HMO Rider |
$685.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$628.21
|
|
|
HC BAL COOK CODA
|
Facility
|
OP
|
$1,918.20
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
906812514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.64 |
| Max. Negotiated Rate |
$1,630.47 |
| Rate for Payer: Adventist Health Commercial |
$383.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,630.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,055.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,438.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,111.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,415.63
|
| Rate for Payer: Blue Shield of California EPN |
$932.25
|
| Rate for Payer: Cash Price |
$863.19
|
| Rate for Payer: Cigna of CA HMO |
$1,342.74
|
| Rate for Payer: Cigna of CA PPO |
$1,342.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,630.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,630.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,630.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$767.28
|
| Rate for Payer: EPIC Health Plan Senior |
$767.28
|
| Rate for Payer: Galaxy Health WC |
$1,630.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1,150.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,279.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,187.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,342.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,342.74
|
| Rate for Payer: Multiplan Commercial |
$1,534.56
|
| Rate for Payer: Networks By Design Commercial |
$959.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,630.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,150.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,150.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$719.90
|
| Rate for Payer: United Healthcare All Other HMO |
$700.72
|
| Rate for Payer: United Healthcare HMO Rider |
$685.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$628.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,630.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,630.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,630.47
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$814.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$683.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$931.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$762.71
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$919.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,055.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,055.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Senior |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$768.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$869.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO |
$621.00
|
| Rate for Payer: United Healthcare HMO Rider |
$621.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,055.70
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Senior |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$768.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.08
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
|
|
HC BALLOON, AMPHIRION
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Adventist Health Commercial |
$368.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,206.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,012.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,380.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,129.94
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$1,177.60
|
| Rate for Payer: Cigna of CA PPO |
$1,361.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,564.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,564.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.00
|
| Rate for Payer: EPIC Health Plan Senior |
$736.00
|
| Rate for Payer: Galaxy Health WC |
$1,564.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,288.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,472.00
|
| Rate for Payer: Networks By Design Commercial |
$1,196.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,104.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,104.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$920.00
|
| Rate for Payer: United Healthcare All Other HMO |
$920.00
|
| Rate for Payer: United Healthcare HMO Rider |
$920.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$920.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,564.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,564.00
|
|
|
HC BALLOON, AMPHIRION
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Adventist Health Commercial |
$368.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.00
|
| Rate for Payer: EPIC Health Plan Senior |
$736.00
|
| Rate for Payer: Galaxy Health WC |
$1,564.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$1,472.00
|
| Rate for Payer: Networks By Design Commercial |
$1,196.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.00
|
|
|
HC BALLOON, ASCENT
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BALLOON, ASCENT
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BALLOON DILATATION CATHETER
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803804
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| 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 BALLOON DILATATION CATHETER
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803804
|
|
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: Aetna of CA HMO/PPO |
$1,062.56
|
| 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 |
$994.84
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| 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 BALLOON, EV3 EVERCROSS
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$664.70 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$512.91
|
| 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 |
$480.23
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO |
$500.48
|
| Rate for Payer: Cigna of CA PPO |
$578.68
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| 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 |
$508.30
|
| 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 |
$391.00
|
| Rate for Payer: United Healthcare All Other HMO |
$391.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| 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 BALLOON, EV3 EVERCROSS
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$664.70 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$351.90
|
| 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 Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| 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
|
|
|
HC BALLOON GATEWAY
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC BALLOON GATEWAY
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,878.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,895.40
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BALLOON HYPERFORM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909020050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BALLOON HYPERFORM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909020050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BALLOON NANOCROSS
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| 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 |
$469.15
|
| Rate for Payer: Blue Shield of California Commercial |
$597.78
|
| Rate for Payer: Blue Shield of California EPN |
$393.66
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$567.00
|
| Rate for Payer: Cigna of CA PPO |
$567.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$501.39
|
| 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 |
$405.00
|
| 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 |
$303.99
|
| Rate for Payer: United Healthcare All Other HMO |
$295.89
|
| Rate for Payer: United Healthcare HMO Rider |
$289.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.27
|
| 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 BALLOON NANOCROSS
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO |
$567.00
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$501.39
|
| 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 |
$405.00
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.99
|
| Rate for Payer: United Healthcare All Other HMO |
$295.89
|
| Rate for Payer: United Healthcare HMO Rider |
$289.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.27
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
IP
|
$2,976.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$2,529.60 |
| Rate for Payer: Adventist Health Commercial |
$595.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,190.40
|
| Rate for Payer: Galaxy Health WC |
$2,529.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,785.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,984.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,133.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,842.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.24
|
| Rate for Payer: Multiplan Commercial |
$2,380.80
|
| Rate for Payer: Networks By Design Commercial |
$1,934.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,529.60
|
|
