|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.00
|
| Rate for Payer: Galaxy Health WC |
$1,088.00
|
| Rate for Payer: Global Benefits Group Commercial |
$768.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: Networks By Design Commercial |
$832.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,088.00
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
OP
|
$13,965.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,258.41 |
| Max. Negotiated Rate |
$13,494.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,870.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,680.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,680.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$6,284.25
|
| Rate for Payer: Cash Price |
$6,284.25
|
| Rate for Payer: Cash Price |
$6,284.25
|
| Rate for Payer: Cigna of CA PPO |
$10,334.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,870.25
|
| Rate for Payer: Dignity Health Media |
$11,870.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,870.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,586.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,586.00
|
| Rate for Payer: Galaxy Health WC |
$11,870.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,379.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,473.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,351.60
|
| Rate for Payer: Multiplan Commercial |
$11,172.00
|
| Rate for Payer: Networks By Design Commercial |
$9,077.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,870.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,379.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,870.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,870.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,870.25
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
IP
|
$13,965.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,351.60 |
| Max. Negotiated Rate |
$11,870.25 |
| Rate for Payer: Cash Price |
$6,284.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,586.00
|
| Rate for Payer: Galaxy Health WC |
$11,870.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,379.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,320.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,351.60
|
| Rate for Payer: Multiplan Commercial |
$11,172.00
|
| Rate for Payer: Networks By Design Commercial |
$9,077.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,870.25
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
OP
|
$4,436.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,209.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,770.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,439.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,439.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,661.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cigna of CA PPO |
$3,282.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,770.60
|
| Rate for Payer: Dignity Health Media |
$3,770.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,770.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.40
|
| Rate for Payer: Galaxy Health WC |
$3,770.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,327.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.64
|
| Rate for Payer: Multiplan Commercial |
$3,548.80
|
| Rate for Payer: Networks By Design Commercial |
$2,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,770.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,661.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,770.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,770.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,770.60
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
IP
|
$4,436.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,064.64 |
| Max. Negotiated Rate |
$3,770.60 |
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.40
|
| Rate for Payer: Galaxy Health WC |
$3,770.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,690.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.64
|
| Rate for Payer: Multiplan Commercial |
$3,548.80
|
| Rate for Payer: Networks By Design Commercial |
$2,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,770.60
|
|
|
HC INTRANASAL BX
|
Facility
|
IP
|
$3,154.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$756.96 |
| Max. Negotiated Rate |
$2,680.90 |
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.60
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.96
|
| Rate for Payer: Multiplan Commercial |
$2,523.20
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
|
|
HC INTRANASAL BX
|
Facility
|
OP
|
$3,154.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,892.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cigna of CA PPO |
$2,333.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,365.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,086.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,086.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$2,523.20
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,892.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTRAOP NEURO TESTING,PER HOUR
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$210.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$766.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$829.95
|
| Rate for Payer: Blue Distinction Transplant |
$835.80
|
| Rate for Payer: Blue Shield of California Commercial |
$823.26
|
| Rate for Payer: Blue Shield of California EPN |
$653.32
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Cigna of CA HMO |
$891.52
|
| Rate for Payer: Cigna of CA PPO |
$1,030.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Dignity Health Media |
$1,184.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,184.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,044.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.32
|
| Rate for Payer: Multiplan Commercial |
$1,114.40
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$835.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$835.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.05
|
|
|
HC INTRAOP NEURO TESTING,PER HOUR
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$334.32 |
| Max. Negotiated Rate |
$1,184.05 |
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.32
|
| Rate for Payer: Multiplan Commercial |
$1,114.40
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$9,930.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.93 |
| Max. Negotiated Rate |
$8,440.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,958.00
|
| Rate for Payer: Cash Price |
$4,468.50
|
| Rate for Payer: Cash Price |
$4,468.50
|
| Rate for Payer: Cash Price |
$4,468.50
|
| Rate for Payer: Cigna of CA PPO |
$7,348.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$8,440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,958.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,447.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,623.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,383.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$7,944.00
|
| Rate for Payer: Networks By Design Commercial |
$6,454.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,440.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,958.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$9,930.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,383.20 |
| Max. Negotiated Rate |
$8,440.50 |
| Rate for Payer: Cash Price |
$4,468.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,972.00
|
| Rate for Payer: Galaxy Health WC |
$8,440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,958.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,623.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,783.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,383.20
|
| Rate for Payer: Multiplan Commercial |
$7,944.00
|
| Rate for Payer: Networks By Design Commercial |
$6,454.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,440.50
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$6,548.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,622.40
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,848.96 |
| Max. Negotiated Rate |
$6,548.40 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$6,125.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$5,206.25 |
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,450.00
|
| Rate for Payer: Galaxy Health WC |
$5,206.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,085.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,333.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.00
|
| Rate for Payer: Multiplan Commercial |
$4,900.00
|
| Rate for Payer: Networks By Design Commercial |
$3,981.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,206.25
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$6,125.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$5,206.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,675.00
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cash Price |
$2,756.25
|
| Rate for Payer: Cigna of CA PPO |
$4,532.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$5,206.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,675.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,593.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,085.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$4,900.00
|
| Rate for Payer: Networks By Design Commercial |
$3,981.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,206.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$2,037.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,222.20
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: Cigna of CA PPO |
$1,507.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,527.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,629.60
|
| Rate for Payer: Networks By Design Commercial |
$1,324.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,222.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,018.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,018.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,018.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,018.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$2,037.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$488.88 |
| Max. Negotiated Rate |
$1,731.45 |
| Rate for Payer: Cash Price |
$916.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$814.80
|
| Rate for Payer: Galaxy Health WC |
$1,731.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,222.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,358.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$776.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.88
|
| Rate for Payer: Multiplan Commercial |
$1,629.60
|
| Rate for Payer: Networks By Design Commercial |
$1,324.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,731.45
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$518.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Media |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$518.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Media |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,472.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.36 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
OP
|
$2,218.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.92 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,362.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,885.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,219.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,219.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,330.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna of CA PPO |
$1,641.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,885.30
|
| Rate for Payer: Dignity Health Media |
$1,885.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,885.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$887.20
|
| Rate for Payer: Galaxy Health WC |
$1,885.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,330.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,663.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,479.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.32
|
| Rate for Payer: Multiplan Commercial |
$1,774.40
|
| Rate for Payer: Networks By Design Commercial |
$1,441.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,885.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,330.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,885.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,885.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,885.30
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
IP
|
$2,218.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.32 |
| Max. Negotiated Rate |
$1,885.30 |
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$887.20
|
| Rate for Payer: Galaxy Health WC |
$1,885.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,330.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,479.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.32
|
| Rate for Payer: Multiplan Commercial |
$1,774.40
|
| Rate for Payer: Networks By Design Commercial |
$1,441.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,885.30
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$331.44 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$828.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Dignity Health Media |
$1,173.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,035.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.85
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$331.44 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
