|
HC BAG TRU-CLOSE 600ML GRAVITY
|
Facility
|
OP
|
$86.56
|
|
| Hospital Charge Code |
901604505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: United Healthcare HMO Rider |
$43.28
|
| Rate for Payer: Adventist Health Commercial |
$17.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.55
|
| Rate for Payer: Cash Price |
$38.95
|
| Rate for Payer: Cigna of CA HMO |
$55.40
|
| Rate for Payer: Cigna of CA PPO |
$64.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.62
|
| Rate for Payer: EPIC Health Plan Senior |
$34.62
|
| Rate for Payer: Galaxy Health WC |
$73.58
|
| Rate for Payer: Global Benefits Group Commercial |
$51.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.59
|
| Rate for Payer: Multiplan Commercial |
$69.25
|
| Rate for Payer: Networks By Design Commercial |
$56.26
|
| Rate for Payer: Prime Health Services Commercial |
$73.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.28
|
| Rate for Payer: United Healthcare All Other HMO |
$43.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.58
|
| Rate for Payer: Vantage Medical Group Senior |
$73.58
|
|
|
HC BAG TRU-CLOSE 600ML GRAVITY
|
Facility
|
IP
|
$86.56
|
|
| Hospital Charge Code |
901604505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Adventist Health Commercial |
$17.31
|
| Rate for Payer: Cash Price |
$38.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.62
|
| Rate for Payer: EPIC Health Plan Senior |
$34.62
|
| Rate for Payer: Galaxy Health WC |
$73.58
|
| Rate for Payer: Global Benefits Group Commercial |
$51.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$69.25
|
| Rate for Payer: Networks By Design Commercial |
$56.26
|
| Rate for Payer: Prime Health Services Commercial |
$73.58
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC BAG URINE CONVEEN LEG BAG
|
Facility
|
OP
|
$40.67
|
|
| Hospital Charge Code |
901602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.10
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$30.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.47
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$20.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
HC BAG URINE CONVEEN LEG BAG
|
Facility
|
IP
|
$40.67
|
|
| Hospital Charge Code |
901602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
|
|
HC BAG VNTRL WALL DFCT SILO 10CM
|
Facility
|
IP
|
$2,231.00
|
|
| Hospital Charge Code |
901604783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
|
HC BAG VNTRL WALL DFCT SILO 10CM
|
Facility
|
OP
|
$2,231.00
|
|
| Hospital Charge Code |
901604783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,463.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,673.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,431.63
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,896.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,896.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$809.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,561.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,561.70
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,896.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,896.35
|
|
|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
IP
|
$1,789.40
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.88 |
| Max. Negotiated Rate |
$1,520.99 |
| Rate for Payer: Cash Price |
$805.23
|
| Rate for Payer: Adventist Health Commercial |
$357.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,252.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$715.76
|
| Rate for Payer: EPIC Health Plan Senior |
$715.76
|
| Rate for Payer: Galaxy Health WC |
$1,520.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,073.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,136.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,055.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.46
|
| Rate for Payer: Multiplan Commercial |
$1,431.52
|
| Rate for Payer: Networks By Design Commercial |
$1,163.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,520.99
|
|
|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
OP
|
$1,789.40
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.88 |
| Max. Negotiated Rate |
$1,520.99 |
| Rate for Payer: Adventist Health Commercial |
$357.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,173.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,520.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$984.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,342.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,148.26
|
| Rate for Payer: Cash Price |
$805.23
|
| Rate for Payer: Cigna of CA HMO |
$1,145.22
|
| Rate for Payer: Cigna of CA PPO |
$1,324.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,520.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,520.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,520.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,252.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$715.76
|
| Rate for Payer: EPIC Health Plan Senior |
$715.76
|
| Rate for Payer: Galaxy Health WC |
$1,520.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,073.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,136.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$649.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,055.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,252.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,252.58
|
| Rate for Payer: Multiplan Commercial |
$1,431.52
|
| Rate for Payer: Networks By Design Commercial |
$1,163.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,520.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,073.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,073.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$894.70
|
| Rate for Payer: United Healthcare All Other HMO |
$894.70
|
| Rate for Payer: United Healthcare HMO Rider |
$894.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,520.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,520.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,520.99
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
IP
|
$2,194.20
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$1,865.07 |
| Rate for Payer: Cash Price |
$987.39
|
| Rate for Payer: Adventist Health Commercial |
$438.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.68
|
| Rate for Payer: EPIC Health Plan Senior |
$877.68
|
| Rate for Payer: Galaxy Health WC |
$1,865.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,393.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,294.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.61
|
| Rate for Payer: Multiplan Commercial |
$1,755.36
|
| Rate for Payer: Networks By Design Commercial |
$1,426.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.07
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
OP
|
$2,194.20
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$1,865.07 |
| Rate for Payer: Adventist Health Commercial |
$438.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,439.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,408.02
|
| Rate for Payer: Cash Price |
$987.39
|
| Rate for Payer: Cigna of CA HMO |
$1,404.29
|
| Rate for Payer: Cigna of CA PPO |
$1,623.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,865.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,865.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.68
|
| Rate for Payer: EPIC Health Plan Senior |
$877.68
|
| Rate for Payer: Galaxy Health WC |
$1,865.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,393.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$796.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,294.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,535.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,535.94
|
| Rate for Payer: Multiplan Commercial |
$1,755.36
|
| Rate for Payer: Networks By Design Commercial |
$1,426.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,097.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,097.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,865.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,865.07
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC BAKRI BALLOON OR JADA DEVICE INSERTION
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
988169899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.05
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cigna of CA HMO |
$408.96
|
| Rate for Payer: Cigna of CA PPO |
$472.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$447.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$543.15
|
| Rate for Payer: Global Benefits Group Commercial |
$383.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$405.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$327.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$415.35
|
| Rate for Payer: Prime Health Services Commercial |
$543.15
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$383.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC BAKRI BALLOON OR JADA DEVICE INSERTION
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
988169899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$543.15 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$447.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.60
|
| Rate for Payer: EPIC Health Plan Senior |
$255.60
|
| Rate for Payer: Galaxy Health WC |
$543.15
|
| Rate for Payer: Global Benefits Group Commercial |
$383.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$405.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$377.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.36
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: Networks By Design Commercial |
$415.35
|
| Rate for Payer: Prime Health Services Commercial |
$543.15
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$732.78
|
| 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 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 |
$488.81
|
| 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 |
$796.99
|
| Rate for Payer: Cash Price |
$558.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$732.78
|
| 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, 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 |
$3,036.30 |
| Rate for Payer: Adventist Health Commercial |
$368.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,036.30
|
| 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 |
$1,180.73
|
| Rate for Payer: Cash Price |
$828.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,288.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,168.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$667.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,085.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,288.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,168.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,085.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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 |
$3,036.30
|
| 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 |
$2,502.63
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| 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: Galaxy Health WC |
$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: 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 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 |
$488.81
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$496.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
