|
HC BRONCH-RADIOELEMENT PLACEMENT
|
Facility
|
OP
|
$3,351.00
|
|
|
Service Code
|
CPT 31643
|
| Hospital Charge Code |
900803506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.10 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$670.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cash Price |
$1,507.95
|
| Rate for Payer: Cigna of CA HMO |
$2,144.64
|
| Rate for Payer: Cigna of CA PPO |
$2,479.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$2,848.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,010.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,235.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$2,680.80
|
| Rate for Payer: Networks By Design Commercial |
$2,178.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,848.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,010.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,010.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,675.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,675.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,675.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC BRONCH W BLLN OCC ADD LOBES
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900831651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$3,105.90 |
| Rate for Payer: Adventist Health Commercial |
$730.80
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,461.60
|
| Rate for Payer: Galaxy Health WC |
$3,105.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,437.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,392.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,261.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.96
|
| Rate for Payer: Multiplan Commercial |
$2,923.20
|
| Rate for Payer: Networks By Design Commercial |
$2,375.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,105.90
|
|
|
HC BRONCH W BLLN OCC ADD LOBES
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900831651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$730.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,009.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,740.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: Cash Price |
$1,644.30
|
| Rate for Payer: Cigna of CA HMO |
$2,338.56
|
| Rate for Payer: Cigna of CA PPO |
$2,703.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,105.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,105.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,461.60
|
| Rate for Payer: Galaxy Health WC |
$3,105.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,192.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,437.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,261.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,557.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,557.80
|
| Rate for Payer: Multiplan Commercial |
$2,923.20
|
| Rate for Payer: Networks By Design Commercial |
$2,375.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,105.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,192.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,105.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,105.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,105.90
|
|
|
HC BRONCH W/BLLN OCCLUSION
|
Facility
|
OP
|
$3,585.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.08 |
| Max. Negotiated Rate |
$14,424.93 |
| Rate for Payer: Adventist Health Commercial |
$717.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,613.25
|
| Rate for Payer: Cash Price |
$1,613.25
|
| Rate for Payer: Cash Price |
$1,613.25
|
| Rate for Payer: Cigna of CA HMO |
$2,294.40
|
| Rate for Payer: Cigna of CA PPO |
$2,652.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,874.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8,795.69
|
| Rate for Payer: Galaxy Health WC |
$3,047.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,151.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,424.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,391.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,795.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,786.22
|
| Rate for Payer: Multiplan Commercial |
$2,868.00
|
| Rate for Payer: Networks By Design Commercial |
$2,330.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,047.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,151.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,151.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,792.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,792.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,792.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,792.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,795.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC BRONCH W/BLLN OCCLUSION
|
Facility
|
IP
|
$3,585.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.00 |
| Max. Negotiated Rate |
$3,047.25 |
| Rate for Payer: Adventist Health Commercial |
$717.00
|
| Rate for Payer: Cash Price |
$1,613.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,434.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,434.00
|
| Rate for Payer: Galaxy Health WC |
$3,047.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,151.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,391.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,365.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,219.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.40
|
| Rate for Payer: Multiplan Commercial |
$2,868.00
|
| Rate for Payer: Networks By Design Commercial |
$2,330.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,047.25
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
|
IP
|
$9,755.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.00 |
| Max. Negotiated Rate |
$8,291.75 |
| Rate for Payer: Adventist Health Commercial |
$1,951.00
|
| Rate for Payer: Cash Price |
$4,389.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,902.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,902.00
|
| Rate for Payer: Galaxy Health WC |
$8,291.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,853.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,506.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,716.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,038.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.20
|
| Rate for Payer: Multiplan Commercial |
$7,804.00
|
| Rate for Payer: Networks By Design Commercial |
$6,340.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,291.75
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
|
OP
|
$9,755.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$630.47 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,951.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,389.75
|
| Rate for Payer: Cash Price |
$4,389.75
|
| Rate for Payer: Cash Price |
$4,389.75
|
| Rate for Payer: Cigna of CA HMO |
$6,243.20
|
| Rate for Payer: Cigna of CA PPO |
$7,218.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,874.18
|
| Rate for Payer: EPIC Health Plan Senior |
$8,795.69
|
| Rate for Payer: Galaxy Health WC |
$8,291.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,853.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,424.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$630.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,506.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$713.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,795.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,786.22
|
| Rate for Payer: Multiplan Commercial |
$7,804.00
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: Networks By Design Commercial |
$6,340.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,291.75
|
| Rate for Payer: Prime Health Services WC |
$13,871.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,853.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,795.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
|
OP
|
$7,511.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.01 |
| Max. Negotiated Rate |
$7,682.81 |
| Rate for Payer: Adventist Health Commercial |
$1,502.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,379.95
|
| Rate for Payer: Cash Price |
$3,379.95
|
| Rate for Payer: Cash Price |
$3,379.95
|
| Rate for Payer: Cigna of CA HMO |
$4,807.04
|
| Rate for Payer: Cigna of CA PPO |
$5,558.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,324.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.64
|
| Rate for Payer: Galaxy Health WC |
$6,384.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,506.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,682.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,009.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,684.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,277.42
|
| Rate for Payer: Multiplan Commercial |
$6,008.80
|
| Rate for Payer: Networks By Design Commercial |
$4,882.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,384.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,506.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,506.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,755.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,755.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,755.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,755.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,684.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
|
IP
|
$7,511.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,502.20 |
| Max. Negotiated Rate |
$6,384.35 |
| Rate for Payer: Adventist Health Commercial |
$1,502.20
|
| Rate for Payer: Cash Price |
$3,379.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,004.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,004.40
|
| Rate for Payer: Galaxy Health WC |
$6,384.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,506.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,009.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,861.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,649.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,802.64
|
| Rate for Payer: Multiplan Commercial |
$6,008.80
|
| Rate for Payer: Networks By Design Commercial |
$4,882.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,384.35
|
|
|
HC B/S EMBLEM 3501
|
Facility
|
OP
|
$12,500.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813815
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,500.00 |
| Max. Negotiated Rate |
$10,625.00 |
| Rate for Payer: Adventist Health Commercial |
$2,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,875.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,676.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9,225.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,075.00
|
| Rate for Payer: Cash Price |
$5,625.00
|
| Rate for Payer: Cigna of CA HMO |
$8,750.00
|
| Rate for Payer: Cigna of CA PPO |
$8,750.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,625.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,625.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,000.00
|
| Rate for Payer: Galaxy Health WC |
$10,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,750.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Networks By Design Commercial |
$6,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,625.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,691.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,566.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,467.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,093.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,625.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,625.00
|
|
|
HC B/S EMBLEM 3501
|
Facility
|
IP
|
$12,500.00
|
|
|
Service Code
|
CPT C1896
|
| Hospital Charge Code |
906813815
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,500.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,625.00
|
| Rate for Payer: Cash Price |
$5,625.00
|
| Rate for Payer: Cigna of CA HMO |
$8,750.00
|
| Rate for Payer: Cigna of CA PPO |
$8,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,000.00
|
| Rate for Payer: Galaxy Health WC |
$10,625.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,762.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,737.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Networks By Design Commercial |
$6,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,625.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,691.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4,566.25
|
| Rate for Payer: United Healthcare HMO Rider |
$4,467.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,093.75
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
IP
|
$941.39
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.28 |
| Max. Negotiated Rate |
$800.18 |
| Rate for Payer: Adventist Health Commercial |
$188.28
|
| Rate for Payer: Cash Price |
$423.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.56
|
| Rate for Payer: EPIC Health Plan Senior |
$376.56
|
| Rate for Payer: Galaxy Health WC |
$800.18
|
| Rate for Payer: Global Benefits Group Commercial |
$564.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.93
|
| Rate for Payer: Multiplan Commercial |
$753.11
|
| Rate for Payer: Networks By Design Commercial |
$611.90
|
| Rate for Payer: Prime Health Services Commercial |
$800.18
|
|
|
HC BTTN MINI 1 12FRX0.8CM BLLN LP
|
Facility
|
OP
|
$941.39
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.28 |
| Max. Negotiated Rate |
$800.18 |
| Rate for Payer: Adventist Health Commercial |
$188.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$617.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$800.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$517.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$706.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.11
|
| Rate for Payer: Cash Price |
$423.63
|
| Rate for Payer: Cigna of CA HMO |
$602.49
|
| Rate for Payer: Cigna of CA PPO |
$696.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$800.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$800.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$800.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.56
|
| Rate for Payer: EPIC Health Plan Senior |
$376.56
|
| Rate for Payer: Galaxy Health WC |
$800.18
|
| Rate for Payer: Global Benefits Group Commercial |
$564.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$658.97
|
| Rate for Payer: Multiplan Commercial |
$753.11
|
| Rate for Payer: Networks By Design Commercial |
$611.90
|
| Rate for Payer: Prime Health Services Commercial |
$800.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$800.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$800.18
|
| Rate for Payer: Vantage Medical Group Senior |
$800.18
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
IP
|
$941.39
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.28 |
| Max. Negotiated Rate |
$800.18 |
| Rate for Payer: Adventist Health Commercial |
$188.28
|
| Rate for Payer: Cash Price |
$423.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.56
|
| Rate for Payer: EPIC Health Plan Senior |
$376.56
|
| Rate for Payer: Galaxy Health WC |
$800.18
|
| Rate for Payer: Global Benefits Group Commercial |
$564.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.93
|
| Rate for Payer: Multiplan Commercial |
$753.11
|
| Rate for Payer: Networks By Design Commercial |
$611.90
|
| Rate for Payer: Prime Health Services Commercial |
$800.18
|
|
|
HC BTTN MINI 1 12FRX1.0CM BLLN LP
|
Facility
|
OP
|
$941.39
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.28 |
| Max. Negotiated Rate |
$800.18 |
| Rate for Payer: Adventist Health Commercial |
$188.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$617.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$800.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$517.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$706.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$578.11
|
| Rate for Payer: Cash Price |
$423.63
|
| Rate for Payer: Cigna of CA HMO |
$602.49
|
| Rate for Payer: Cigna of CA PPO |
$696.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$800.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$800.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$800.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.56
|
| Rate for Payer: EPIC Health Plan Senior |
$376.56
|
| Rate for Payer: Galaxy Health WC |
$800.18
|
| Rate for Payer: Global Benefits Group Commercial |
$564.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$658.97
|
| Rate for Payer: Multiplan Commercial |
$753.11
|
| Rate for Payer: Networks By Design Commercial |
$611.90
|
| Rate for Payer: Prime Health Services Commercial |
$800.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$800.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$800.18
|
| Rate for Payer: Vantage Medical Group Senior |
$800.18
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
OP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$209.92 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.66
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: Cigna of CA HMO |
$158.05
|
| Rate for Payer: Cigna of CA PPO |
$182.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.87
|
| Rate for Payer: Multiplan Commercial |
$197.57
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.48
|
| Rate for Payer: United Healthcare HMO Rider |
$123.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.92
|
| Rate for Payer: Vantage Medical Group Senior |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.0CM BLLN LP
|
Facility
|
IP
|
$246.96
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.39 |
| Max. Negotiated Rate |
$209.92 |
| Rate for Payer: Adventist Health Commercial |
$49.39
|
| Rate for Payer: Cash Price |
$111.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.78
|
| Rate for Payer: EPIC Health Plan Senior |
$98.78
|
| Rate for Payer: Galaxy Health WC |
$209.92
|
| Rate for Payer: Global Benefits Group Commercial |
$148.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.27
|
| Rate for Payer: Multiplan Commercial |
$197.57
|
| Rate for Payer: Networks By Design Commercial |
$160.52
|
| Rate for Payer: Prime Health Services Commercial |
$209.92
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.2CM BLLN LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
IP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$483.14 |
| Rate for Payer: Adventist Health Commercial |
$113.68
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: EPIC Health Plan Senior |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$351.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.42
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
|
|
HC BTTN MINI 1 14FRX1.7CM BLLN LP
|
Facility
|
OP
|
$568.40
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$483.14 |
| Rate for Payer: Adventist Health Commercial |
$113.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$372.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.05
|
| Rate for Payer: Cash Price |
$255.78
|
| Rate for Payer: Cigna of CA HMO |
$363.78
|
| Rate for Payer: Cigna of CA PPO |
$420.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.36
|
| Rate for Payer: EPIC Health Plan Senior |
$227.36
|
| Rate for Payer: Galaxy Health WC |
$483.14
|
| Rate for Payer: Global Benefits Group Commercial |
$341.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$351.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$397.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$397.88
|
| Rate for Payer: Multiplan Commercial |
$454.72
|
| Rate for Payer: Networks By Design Commercial |
$369.46
|
| Rate for Payer: Prime Health Services Commercial |
$483.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$284.20
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$284.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.14
|
| Rate for Payer: Vantage Medical Group Senior |
$483.14
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
IP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$546.93 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.43
|
| Rate for Payer: Multiplan Commercial |
$514.76
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
|
|
HC BTTN MINI 1 14FRX2.0CM BLLN LP
|
Facility
|
OP
|
$643.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$546.93 |
| Rate for Payer: Adventist Health Commercial |
$128.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$422.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$482.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.14
|
| Rate for Payer: Cash Price |
$289.55
|
| Rate for Payer: Cigna of CA HMO |
$411.81
|
| Rate for Payer: Cigna of CA PPO |
$476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$546.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.38
|
| Rate for Payer: EPIC Health Plan Senior |
$257.38
|
| Rate for Payer: Galaxy Health WC |
$546.93
|
| Rate for Payer: Global Benefits Group Commercial |
$386.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.42
|
| Rate for Payer: Multiplan Commercial |
$514.76
|
| Rate for Payer: Networks By Design Commercial |
$418.24
|
| Rate for Payer: Prime Health Services Commercial |
$546.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.73
|
| Rate for Payer: United Healthcare All Other HMO |
$321.73
|
| Rate for Payer: United Healthcare HMO Rider |
$321.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.93
|
| Rate for Payer: Vantage Medical Group Senior |
$546.93
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
IP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$435.71 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$317.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.02
|
| Rate for Payer: Multiplan Commercial |
$410.08
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
|
|
HC BTTN MINI 14FRX1.5CM
|
Facility
|
OP
|
$512.60
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901696295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$435.71 |
| Rate for Payer: Adventist Health Commercial |
$102.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$336.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$384.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.79
|
| Rate for Payer: Cash Price |
$230.67
|
| Rate for Payer: Cigna of CA HMO |
$328.06
|
| Rate for Payer: Cigna of CA PPO |
$379.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.04
|
| Rate for Payer: EPIC Health Plan Senior |
$205.04
|
| Rate for Payer: Galaxy Health WC |
$435.71
|
| Rate for Payer: Global Benefits Group Commercial |
$307.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$317.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.82
|
| Rate for Payer: Multiplan Commercial |
$410.08
|
| Rate for Payer: Networks By Design Commercial |
$333.19
|
| Rate for Payer: Prime Health Services Commercial |
$435.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.30
|
| Rate for Payer: United Healthcare All Other HMO |
$256.30
|
| Rate for Payer: United Healthcare HMO Rider |
$256.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$435.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.71
|
| Rate for Payer: Vantage Medical Group Senior |
$435.71
|
|
