|
HC ELECT STIM UNATTENDED ULCERS MCAL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901301303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.75
|
|
|
HC ELECT STIM UNATTENDED/ULCERS MCAL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT G0281
|
| Hospital Charge Code |
901300083
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cigna of CA HMO |
$78.08
|
| Rate for Payer: Cigna of CA PPO |
$90.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,510.70
|
| 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 |
$8,274.50
|
| 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 |
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 |
$7,705.47
|
| Rate for Payer: Blue Shield of California Commercial |
$6,454.11
|
| Rate for Payer: Blue Shield of California Commercial |
$9,789.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,510.70
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,510.70
|
| 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 |
$8,274.50
|
| 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 |
$7,705.47
|
| Rate for Payer: Blue Shield of California Commercial |
$6,454.11
|
| Rate for Payer: Blue Shield of California Commercial |
$9,789.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,510.70
|
| 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 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 |
$9,759.00 |
| 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 |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,150.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,858.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,273.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,150.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,858.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,655.59
|
| 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 EMBOLIC ONYX
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,540.00
|
| 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 |
$3,631.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,042.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,614.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,810.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,178.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,540.00
|
| 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
|
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.22
|
| 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 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 |
$216.70
|
| Rate for Payer: Blue Shield of California Commercial |
$181.51
|
| Rate for Payer: Blue Shield of California Commercial |
$275.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.22
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,500.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15,875.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,750.00
|
| 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 |
$16,042.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,500.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15,875.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,075.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,750.00
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,628.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,177.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,172.34
|
| 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, 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 |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,628.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,177.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,358.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$11,163.00
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
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 |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 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 |
$2,821.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,078.25
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,792.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,596.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,594.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,078.25
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,792.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,594.53
|
| 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
|
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: 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 |
$679.39
|
| Rate for Payer: Blue Shield of California Commercial |
$569.06
|
| Rate for Payer: Blue Shield of California Commercial |
$863.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$712.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$407.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$662.22
|
| 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 EMBOLIZATION PARTICLE
|
Facility
|
IP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$712.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$662.22
|
| 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
|
|
