|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
915357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
905357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,055.20 |
| Max. Negotiated Rate |
$10,820.50 |
| Rate for Payer: Adventist Health Commercial |
$5,219.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,001.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,547.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,373.22
|
| Rate for Payer: Blue Shield of California Commercial |
$9,394.74
|
| Rate for Payer: Blue Shield of California EPN |
$6,186.78
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,820.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,911.00
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,820.50
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
915357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,055.20 |
| Max. Negotiated Rate |
$10,820.50 |
| Rate for Payer: Adventist Health Commercial |
$5,219.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,001.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,547.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,373.22
|
| Rate for Payer: Blue Shield of California Commercial |
$9,394.74
|
| Rate for Payer: Blue Shield of California EPN |
$6,186.78
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,820.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,911.00
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,820.50
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
905357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
IP
|
$4,501.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$3,825.85 |
| Rate for Payer: Adventist Health Commercial |
$900.20
|
| Rate for Payer: Cash Price |
$2,025.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.40
|
| Rate for Payer: Galaxy Health WC |
$3,825.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,714.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.24
|
| Rate for Payer: Multiplan Commercial |
$3,600.80
|
| Rate for Payer: Networks By Design Commercial |
$2,925.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.85
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
OP
|
$4,501.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$9,339.00 |
| Rate for Payer: Adventist Health Commercial |
$900.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Cash Price |
$2,025.45
|
| Rate for Payer: Cash Price |
$2,025.45
|
| Rate for Payer: Cash Price |
$2,025.45
|
| Rate for Payer: Cigna of CA HMO |
$2,880.64
|
| Rate for Payer: Cigna of CA PPO |
$3,330.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$3,825.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$3,600.80
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$2,925.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.85
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,700.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,250.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,250.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,250.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,250.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC EMBOLIC ONYX
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,714.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$4,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2,144.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,965.00
|
|
|
HC EMBOLIC ONYX
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$5,100.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,475.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,428.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,916.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,100.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,714.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,200.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,800.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2,144.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,100.00
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.35
|
| Rate for Payer: Blue Shield of California Commercial |
$264.20
|
| Rate for Payer: Blue Shield of California EPN |
$173.99
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.60
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$179.00
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.36
|
| Rate for Payer: United Healthcare All Other HMO |
$130.78
|
| Rate for Payer: United Healthcare HMO Rider |
$127.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.92
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Networks By Design Commercial |
$179.00
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.36
|
| Rate for Payer: United Healthcare All Other HMO |
$130.78
|
| Rate for Payer: United Healthcare HMO Rider |
$127.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16,397.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,352.50
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO |
$16,000.00
|
| Rate for Payer: Cigna of CA PPO |
$18,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$20,000.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$22,326.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.67 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$4,465.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: Cigna of CA HMO |
$14,288.64
|
| Rate for Payer: Cigna of CA PPO |
$16,521.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$18,977.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,395.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,891.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,358.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$17,860.80
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$14,511.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,977.10
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,395.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
IP
|
$22,326.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,465.20 |
| Max. Negotiated Rate |
$18,977.10 |
| Rate for Payer: Adventist Health Commercial |
$4,465.20
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,930.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,930.40
|
| Rate for Payer: Galaxy Health WC |
$18,977.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,395.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,891.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,506.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,819.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,358.24
|
| Rate for Payer: Multiplan Commercial |
$17,860.80
|
| Rate for Payer: Networks By Design Commercial |
$14,511.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,977.10
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
OP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,884.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,418.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,298.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,700.50
|
| Rate for Payer: Cash Price |
$1,978.88
|
| Rate for Payer: Cigna of CA HMO |
$2,814.40
|
| Rate for Payer: Cigna of CA PPO |
$3,254.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,737.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,737.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,759.00
|
| Rate for Payer: Galaxy Health WC |
$3,737.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,722.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,078.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,078.25
|
| Rate for Payer: Multiplan Commercial |
$3,518.00
|
| Rate for Payer: Networks By Design Commercial |
$2,858.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,638.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,638.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,198.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,198.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,198.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,737.88
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
IP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Cash Price |
$1,978.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,759.00
|
| Rate for Payer: Galaxy Health WC |
$3,737.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,722.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.40
|
| Rate for Payer: Multiplan Commercial |
$3,518.00
|
| Rate for Payer: Networks By Design Commercial |
$2,858.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.88
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
IP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cigna of CA HMO |
$785.68
|
| Rate for Payer: Cigna of CA PPO |
$785.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.96
|
| Rate for Payer: EPIC Health Plan Senior |
$448.96
|
| Rate for Payer: Galaxy Health WC |
$954.04
|
| Rate for Payer: Global Benefits Group Commercial |
$673.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.38
|
| Rate for Payer: Multiplan Commercial |
$897.92
|
| Rate for Payer: Networks By Design Commercial |
$561.20
|
| Rate for Payer: Prime Health Services Commercial |
$954.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.24
|
| Rate for Payer: United Healthcare All Other HMO |
$410.01
|
| Rate for Payer: United Healthcare HMO Rider |
$401.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.59
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
OP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$954.04 |
| Rate for Payer: EPIC Health Plan Senior |
$448.96
|
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.09
|
| Rate for Payer: Blue Shield of California Commercial |
$828.33
|
| Rate for Payer: Blue Shield of California EPN |
$545.49
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cigna of CA HMO |
$785.68
|
| Rate for Payer: Cigna of CA PPO |
$785.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$954.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$954.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$954.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.96
|
| Rate for Payer: Galaxy Health WC |
$954.04
|
| Rate for Payer: Global Benefits Group Commercial |
$673.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$785.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$785.68
|
| Rate for Payer: Multiplan Commercial |
$897.92
|
| Rate for Payer: Networks By Design Commercial |
$561.20
|
| Rate for Payer: Prime Health Services Commercial |
$954.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.24
|
| Rate for Payer: United Healthcare All Other HMO |
$410.01
|
| Rate for Payer: United Healthcare HMO Rider |
$401.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$954.04
|
| Rate for Payer: Vantage Medical Group Senior |
$954.04
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
OP
|
$6,914.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,802.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,185.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: Cigna of CA HMO |
$4,424.96
|
| Rate for Payer: Cigna of CA PPO |
$5,116.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,876.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,876.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,402.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,585.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,839.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,839.80
|
| Rate for Payer: Multiplan Commercial |
$5,531.20
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,876.90
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
IP
|
$6,914.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$5,876.90 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,634.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.36
|
| Rate for Payer: Multiplan Commercial |
$5,531.20
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
|
|
HC EM EMBED ONLY
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$507.45 |
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.28
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
|
|
HC EM EMBED ONLY
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$278.80 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.42
|
| Rate for Payer: Blue Shield of California Commercial |
$219.43
|
| Rate for Payer: Blue Shield of California EPN |
$144.98
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC END ABL THY INC VEIN 1ST VEIN
|
Facility
|
IP
|
$11,447.00
|
|
|
Service Code
|
CPT 36482
|
| Hospital Charge Code |
909026482
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,289.40 |
| Max. Negotiated Rate |
$9,729.95 |
| Rate for Payer: Adventist Health Commercial |
$2,289.40
|
| Rate for Payer: Cash Price |
$5,151.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,578.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,578.80
|
| Rate for Payer: Galaxy Health WC |
$9,729.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,868.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,635.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,361.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,085.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,747.28
|
| Rate for Payer: Multiplan Commercial |
$9,157.60
|
| Rate for Payer: Networks By Design Commercial |
$7,440.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,729.95
|
|
