|
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 |
$3,036.30 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,036.30
|
| 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 |
$501.81
|
| Rate for Payer: Cash Price |
$351.90
|
| 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: 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 Medi-Cal |
$283.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Networks By Design Commercial |
$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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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 |
$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 |
$2,360.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.10
|
| 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: 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 |
$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
|
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: 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 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 |
$2,616.32
|
| 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 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 |
$490.29
|
| Rate for Payer: Blue Shield of California Commercial |
$410.67
|
| Rate for Payer: Blue Shield of California Commercial |
$622.89
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$514.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,083.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,889.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,755.84
|
| 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
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$595.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,083.20
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,889.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,755.84
|
| 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 |
$1,488.00
|
| 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
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$2,616.32 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,616.32
|
| 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 |
$346.52
|
| Rate for Payer: Cash Price |
$243.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| 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, 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| 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, 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 |
$3,036.30 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,036.30
|
| 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 |
$664.16
|
| Rate for Payer: Cash Price |
$465.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| 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 |
$1,296.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,647.51
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,360.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$777.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,264.02
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$428.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,360.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,264.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| 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 |
$3,036.30 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,036.30
|
| 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 |
$1,328.32
|
| Rate for Payer: Cash Price |
$931.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$751.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| 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 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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,158.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,493.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,712.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.34
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,158.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,493.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.34
|
| 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 BARBITUATES CONF & ID
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.41
|
| Rate for Payer: Blue Shield of California Commercial |
$217.46
|
| Rate for Payer: Blue Shield of California Commercial |
$119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$180.52
|
| Rate for Payer: Blue Shield of California Commercial |
$143.83
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA HMO |
$199.68
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Cigna of CA PPO |
$230.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$181.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$164.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
IP
|
$2,180.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$436.00 |
| Max. Negotiated Rate |
$1,853.00 |
| Rate for Payer: Adventist Health Commercial |
$436.00
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,526.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$872.00
|
| Rate for Payer: EPIC Health Plan Senior |
$872.00
|
| Rate for Payer: Galaxy Health WC |
$1,853.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,308.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,384.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,286.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.20
|
| Rate for Payer: Multiplan Commercial |
$1,744.00
|
| Rate for Payer: Networks By Design Commercial |
$1,417.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,853.00
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
OP
|
$2,180.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.57 |
| Max. Negotiated Rate |
$1,853.00 |
| Rate for Payer: Adventist Health Commercial |
$436.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,022.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$570.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,390.84
|
| Rate for Payer: Blue Shield of California Commercial |
$917.78
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cash Price |
$981.00
|
| Rate for Payer: Cigna of CA HMO |
$1,395.20
|
| Rate for Payer: Cigna of CA PPO |
$1,613.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,526.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,853.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,308.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,384.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,744.00
|
| Rate for Payer: Networks By Design Commercial |
$1,417.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,853.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,308.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,308.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC BARRIER ASSURA EXTD 3/8-1 7/8"
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC BARRIER ASSURA EXTD 3/8-1 7/8"
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$17.73 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.52
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.29
|
|
