|
HC DECLOT VAD CATH THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
940100110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$628.80
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,048.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$973.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
|
OP
|
$4,582.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.28 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$916.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,520.10
|
| Rate for Payer: Cash Price |
$2,520.10
|
| Rate for Payer: Cash Price |
$2,520.10
|
| Rate for Payer: Cigna of CA HMO |
$2,932.48
|
| Rate for Payer: Cigna of CA PPO |
$3,390.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$3,894.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,749.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,056.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$3,665.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$2,978.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,894.70
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,749.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,291.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,291.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,291.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC DECOMPRESSION LOWER LEG
|
Facility
|
IP
|
$4,582.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
900501510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$916.40 |
| Max. Negotiated Rate |
$3,894.70 |
| Rate for Payer: Adventist Health Commercial |
$916.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,381.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,226.85
|
| Rate for Payer: Cash Price |
$2,520.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,832.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,832.80
|
| Rate for Payer: Galaxy Health WC |
$3,894.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,749.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,056.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,745.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,836.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.68
|
| Rate for Payer: Multiplan Commercial |
$3,665.60
|
| Rate for Payer: Networks By Design Commercial |
$2,978.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,894.70
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
IP
|
$8,479.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,695.80 |
| Max. Negotiated Rate |
$7,207.15 |
| Rate for Payer: Adventist Health Commercial |
$1,695.80
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,391.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,391.60
|
| Rate for Payer: Galaxy Health WC |
$7,207.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,087.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,655.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,248.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,034.96
|
| Rate for Payer: Multiplan Commercial |
$6,783.20
|
| Rate for Payer: Networks By Design Commercial |
$5,511.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,207.15
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$8,479.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$7,207.15 |
| Rate for Payer: Adventist Health Commercial |
$1,695.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: Cigna of CA HMO |
$5,426.56
|
| Rate for Payer: Cigna of CA PPO |
$6,274.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$7,207.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,087.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,655.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,034.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,783.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,511.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,207.15
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,087.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,239.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,239.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,239.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,239.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$8,479.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$149.37 |
| Max. Negotiated Rate |
$7,207.15 |
| Rate for Payer: Cigna of CA HMO |
$5,426.56
|
| Rate for Payer: Adventist Health Commercial |
$1,695.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,561.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: Cigna of CA PPO |
$6,274.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$7,207.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,087.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,655.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,034.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,783.20
|
| Rate for Payer: Networks By Design Commercial |
$5,511.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,207.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,087.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,087.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
IP
|
$8,479.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,695.80 |
| Max. Negotiated Rate |
$7,207.15 |
| Rate for Payer: Adventist Health Commercial |
$1,695.80
|
| Rate for Payer: Cash Price |
$4,663.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,391.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,391.60
|
| Rate for Payer: Galaxy Health WC |
$7,207.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,087.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,655.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,248.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,034.96
|
| Rate for Payer: Multiplan Commercial |
$6,783.20
|
| Rate for Payer: Networks By Design Commercial |
$5,511.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,207.15
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$423.83 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.74
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.50
|
| Rate for Payer: United Healthcare All Other HMO |
$189.50
|
| Rate for Payer: United Healthcare HMO Rider |
$189.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
915353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$72.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.10
|
| Rate for Payer: Blue Shield of California Commercial |
$131.36
|
| Rate for Payer: Blue Shield of California EPN |
$86.51
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$72.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.10
|
| Rate for Payer: Blue Shield of California Commercial |
$131.36
|
| Rate for Payer: Blue Shield of California EPN |
$86.51
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
915353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.80
|
| Rate for Payer: United Healthcare All Other HMO |
$65.02
|
| Rate for Payer: United Healthcare HMO Rider |
$63.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.30
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
IP
|
$663.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$563.55 |
| Rate for Payer: Adventist Health Commercial |
$132.60
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.12
|
| Rate for Payer: Multiplan Commercial |
$530.40
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
OP
|
$663.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$563.55 |
| Rate for Payer: Adventist Health Commercial |
$132.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$434.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.15
|
| Rate for Payer: Blue Shield of California Commercial |
$405.76
|
| Rate for Payer: Blue Shield of California EPN |
$267.85
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: Cigna of CA HMO |
$424.32
|
| Rate for Payer: Cigna of CA PPO |
$490.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$563.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$563.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$563.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$464.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$464.10
|
| Rate for Payer: Multiplan Commercial |
$530.40
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.50
|
| Rate for Payer: United Healthcare All Other HMO |
$331.50
|
| Rate for Payer: United Healthcare HMO Rider |
$331.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$563.55
|
| Rate for Payer: Vantage Medical Group Senior |
$563.55
|
|
|
HC DERMABOND
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC DERMABOND
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.51
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$10,583.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$299.31 |
| Max. Negotiated Rate |
$8,995.55 |
| Rate for Payer: Adventist Health Commercial |
$2,116.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,941.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,476.80
|
| Rate for Payer: Blue Shield of California EPN |
$4,275.53
|
| Rate for Payer: Cash Price |
$5,820.65
|
| Rate for Payer: Cash Price |
$5,820.65
|
| Rate for Payer: Cigna of CA HMO |
$6,773.12
|
| Rate for Payer: Cigna of CA PPO |
$7,831.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,995.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,349.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,058.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,466.40
|
| Rate for Payer: Networks By Design Commercial |
$6,878.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,995.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$7,823.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$299.31 |
| Max. Negotiated Rate |
$6,649.55 |
| Rate for Payer: Adventist Health Commercial |
$1,564.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,131.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4,787.68
|
| Rate for Payer: Blue Shield of California EPN |
$3,160.49
|
| Rate for Payer: Cash Price |
$4,302.65
|
| Rate for Payer: Cash Price |
$4,302.65
|
| Rate for Payer: Cigna of CA HMO |
$5,006.72
|
| Rate for Payer: Cigna of CA PPO |
$5,789.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,649.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,693.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$299.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,217.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$6,258.40
|
| Rate for Payer: Networks By Design Commercial |
$5,084.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,649.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,693.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,693.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$7,823.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,564.60 |
| Max. Negotiated Rate |
$6,649.55 |
| Rate for Payer: Adventist Health Commercial |
$1,564.60
|
| Rate for Payer: Cash Price |
$4,302.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,129.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,129.20
|
| Rate for Payer: Galaxy Health WC |
$6,649.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,693.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,217.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,980.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,842.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.52
|
| Rate for Payer: Multiplan Commercial |
$6,258.40
|
| Rate for Payer: Networks By Design Commercial |
$5,084.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,649.55
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$10,583.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,116.60 |
| Max. Negotiated Rate |
$8,995.55 |
| Rate for Payer: Adventist Health Commercial |
$2,116.60
|
| Rate for Payer: Cash Price |
$5,820.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,233.20
|
| Rate for Payer: Galaxy Health WC |
$8,995.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,058.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,032.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,550.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.92
|
| Rate for Payer: Multiplan Commercial |
$8,466.40
|
| Rate for Payer: Networks By Design Commercial |
$6,878.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,995.55
|
|
