|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
OP
|
$2,976.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$595.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,529.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,636.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,232.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cash Price |
$1,339.20
|
| Rate for Payer: Cigna of CA HMO |
$1,904.64
|
| Rate for Payer: Cigna of CA PPO |
$2,202.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,529.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,529.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,529.60
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,984.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.49
|
| 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: Molina Healthcare of CA Medi-Cal |
$2,083.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,083.20
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,785.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,529.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,529.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,529.60
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$354.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$331.61
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.00
|
| Rate for Payer: United Healthcare All Other HMO |
$270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$270.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$678.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.59
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$724.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO |
$517.50
|
| Rate for Payer: United Healthcare HMO Rider |
$517.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC BALLOON UTERINE 24 FR DIA 54CML SILICONE
|
Facility
|
OP
|
$2,142.40
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901698135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.48 |
| Max. Negotiated Rate |
$1,821.04 |
| Rate for Payer: Adventist Health Commercial |
$428.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,821.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,178.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,606.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,240.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,581.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,041.21
|
| Rate for Payer: Cash Price |
$964.08
|
| Rate for Payer: Cigna of CA HMO |
$1,499.68
|
| Rate for Payer: Cigna of CA PPO |
$1,499.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,821.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,821.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,821.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$856.96
|
| Rate for Payer: EPIC Health Plan Senior |
$856.96
|
| Rate for Payer: Galaxy Health WC |
$1,821.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,428.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,326.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,499.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,499.68
|
| Rate for Payer: Multiplan Commercial |
$1,713.92
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,285.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,285.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.04
|
| Rate for Payer: United Healthcare All Other HMO |
$782.62
|
| Rate for Payer: United Healthcare HMO Rider |
$765.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,821.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,821.04
|
| Rate for Payer: Vantage Medical Group Senior |
$1,821.04
|
|
|
HC BALLOON UTERINE 24 FR DIA 54CML SILICONE
|
Facility
|
IP
|
$2,142.40
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901698135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.48 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$428.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$964.08
|
| Rate for Payer: Cash Price |
$964.08
|
| Rate for Payer: Cigna of CA HMO |
$1,499.68
|
| Rate for Payer: Cigna of CA PPO |
$1,499.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$856.96
|
| Rate for Payer: EPIC Health Plan Senior |
$856.96
|
| Rate for Payer: Galaxy Health WC |
$1,821.04
|
| Rate for Payer: Global Benefits Group Commercial |
$1,285.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,428.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,326.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.18
|
| Rate for Payer: Multiplan Commercial |
$1,713.92
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,821.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.04
|
| Rate for Payer: United Healthcare All Other HMO |
$782.62
|
| Rate for Payer: United Healthcare HMO Rider |
$765.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.64
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,357.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,271.19
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC BAL MED ENSEMBLE NU10 DEL CATH
|
Facility
|
IP
|
$16,250.00
|
|
| Hospital Charge Code |
906812445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,250.00 |
| Max. Negotiated Rate |
$13,812.50 |
| Rate for Payer: Adventist Health Commercial |
$3,250.00
|
| Rate for Payer: Cash Price |
$7,312.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,500.00
|
| Rate for Payer: Galaxy Health WC |
$13,812.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,191.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,058.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,900.00
|
| Rate for Payer: Multiplan Commercial |
$13,000.00
|
| Rate for Payer: Networks By Design Commercial |
$10,562.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,812.50
|
|
|
HC BAL MED ENSEMBLE NU10 DEL CATH
|
Facility
|
OP
|
$16,250.00
|
|
| Hospital Charge Code |
906812445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,250.00 |
| Max. Negotiated Rate |
$13,812.50 |
| Rate for Payer: Adventist Health Commercial |
$3,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,658.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,812.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,937.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,979.12
|
| Rate for Payer: Cash Price |
$7,312.50
|
| Rate for Payer: Cigna of CA HMO |
$10,400.00
|
| Rate for Payer: Cigna of CA PPO |
$12,025.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,812.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,812.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,500.00
|
| Rate for Payer: Galaxy Health WC |
$13,812.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,191.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,058.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,900.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,375.00
|
| Rate for Payer: Multiplan Commercial |
$13,000.00
|
| Rate for Payer: Networks By Design Commercial |
$10,562.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,812.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,812.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,812.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,812.50
|
|
|
HC BAL MED IN-PACT ADMIRAL 120MM
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$820.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna of CA HMO |
$2,870.00
|
| Rate for Payer: Cigna of CA PPO |
$2,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,640.00
|
| Rate for Payer: Galaxy Health WC |
$3,485.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,460.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,734.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,562.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,537.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.00
|
| Rate for Payer: Multiplan Commercial |
$3,280.00
|
| Rate for Payer: Networks By Design Commercial |
$2,050.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,485.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,538.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,497.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,465.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,342.75
|
|
|
HC BAL MED IN-PACT ADMIRAL 120MM
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$3,485.00 |
| Rate for Payer: Networks By Design Commercial |
$2,050.00
|
| Rate for Payer: Adventist Health Commercial |
$820.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,485.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,255.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,075.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,374.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3,025.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna of CA HMO |
$2,870.00
|
| Rate for Payer: Cigna of CA PPO |
$2,870.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,485.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,485.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,485.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,640.00
|
| Rate for Payer: Galaxy Health WC |
$3,485.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,460.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,734.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,562.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,537.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$984.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.00
|
| Rate for Payer: Multiplan Commercial |
$3,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,485.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,460.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,460.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,538.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,497.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,465.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,342.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,485.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,485.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,485.00
|
|
|
HC BAL MED IN-PACT ADMIRAL 40-80MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812664
|
|
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 BAL MED IN-PACT ADMIRAL 40-80MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812664
|
|
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 BAL NUMED BIB
|
Facility
|
OP
|
$2,925.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,486.25 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,918.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,796.24
|
| Rate for Payer: Cash Price |
$1,316.25
|
| Rate for Payer: Cigna of CA HMO |
$1,872.00
|
| Rate for Payer: Cigna of CA PPO |
$2,164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,901.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,462.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,462.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC BAL NUMED BIB
|
Facility
|
IP
|
$2,925.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,486.25 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Cash Price |
$1,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,901.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
|
|
HC BAL SEPTOSTOMY
|
Facility
|
IP
|
$10,226.00
|
|
|
Service Code
|
CPT 92992
|
| Hospital Charge Code |
906811114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,045.20 |
| Max. Negotiated Rate |
$8,692.10 |
| Rate for Payer: Adventist Health Commercial |
$2,045.20
|
| Rate for Payer: Cash Price |
$4,601.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.40
|
| Rate for Payer: Galaxy Health WC |
$8,692.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,820.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,896.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,329.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.24
|
| Rate for Payer: Multiplan Commercial |
$8,180.80
|
| Rate for Payer: Networks By Design Commercial |
$6,646.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.10
|
|
|
HC BAL SEPTOSTOMY
|
Facility
|
OP
|
$10,226.00
|
|
|
Service Code
|
CPT 92992
|
| Hospital Charge Code |
906811114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,045.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,045.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,692.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,624.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,669.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,601.70
|
| Rate for Payer: Cash Price |
$4,601.70
|
| Rate for Payer: Cigna of CA HMO |
$6,646.90
|
| Rate for Payer: Cigna of CA PPO |
$7,567.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,692.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,692.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,692.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.40
|
| Rate for Payer: Galaxy Health WC |
$8,692.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,820.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,896.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,329.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,158.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,158.20
|
| Rate for Payer: Multiplan Commercial |
$8,180.80
|
| Rate for Payer: Networks By Design Commercial |
$6,646.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,113.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,113.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,113.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,692.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,692.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,692.10
|
|
|
HC BAL SPECTÂ BRIDGE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
906812685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC BAL SPECTÂ BRIDGE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
906812685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,174.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,823.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,486.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,035.74
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,817.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,817.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,320.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,320.50
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,657.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,657.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,657.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,657.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,817.75
|
|
|
HC BAL TRIREME CHOCOLATE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,823.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,486.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,920.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,446.47
|
| Rate for Payer: Blue Shield of California EPN |
$1,611.09
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cigna of CA HMO |
$2,320.50
|
| Rate for Payer: Cigna of CA PPO |
$2,320.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,817.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,817.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,320.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,320.50
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,244.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,184.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,085.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,817.75
|
|
|
HC BAL TRIREME CHOCOLATE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cigna of CA HMO |
$2,320.50
|
| Rate for Payer: Cigna of CA PPO |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,652.00
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,244.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,210.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1,184.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,085.66
|
|
|
HC BAL TRIREME GLIDER
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$785.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.47
|
| Rate for Payer: Blue Shield of California EPN |
$659.50
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$814.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$814.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC BAL TRIREME GLIDER
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
|
