|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$1,954.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$1,660.90 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,367.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$781.60
|
| Rate for Payer: EPIC Health Plan Senior |
$781.60
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,240.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,152.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.96
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$1,954.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$1,660.90 |
| Rate for Payer: Adventist Health Commercial |
$390.80
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,367.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$781.60
|
| Rate for Payer: EPIC Health Plan Senior |
$781.60
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,240.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,152.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.96
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$1,954.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$801.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$661.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna of CA HMO |
$1,250.56
|
| Rate for Payer: Cigna of CA PPO |
$1,445.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,367.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$1,660.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,172.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,240.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,563.20
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,270.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,660.90
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,172.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,172.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC ENDOTRACH STYLET FLEXSLIP 14FR
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.21
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC ENDOTRACH STYLET FLEXSLIP 14FR
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC ENDOTRACH TUBE INTRO 15FRX70CM
|
Facility
|
IP
|
$71.42
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$60.71 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$57.14
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
|
HC ENDOTRACH TUBE INTRO 15FRX70CM
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$266.83 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$266.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.83
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.99
|
| Rate for Payer: Multiplan Commercial |
$57.14
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.90
|
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.47
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.41
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
OP
|
$4,140.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$828.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,277.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: Cigna of CA HMO |
$2,649.60
|
| Rate for Payer: Cigna of CA PPO |
$3,063.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,519.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,519.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,898.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,656.00
|
| Rate for Payer: Galaxy Health WC |
$3,519.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,484.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,628.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,898.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,898.00
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,691.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,519.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,484.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,070.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,519.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,519.00
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
IP
|
$4,140.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$828.00 |
| Max. Negotiated Rate |
$3,519.00 |
| Rate for Payer: Adventist Health Commercial |
$828.00
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,898.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,656.00
|
| Rate for Payer: Galaxy Health WC |
$3,519.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,484.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,628.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.60
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,691.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,519.00
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$22,326.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$24,498.80 |
| Rate for Payer: Adventist Health Commercial |
$4,465.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,490.21
|
| 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 |
$9,399.25
|
| Rate for Payer: Blue Shield of California Commercial |
$14,243.99
|
| 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 |
$100.70
|
| 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 |
$113.89
|
| 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: Networks By Design Commercial |
$14,511.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,977.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,395.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,395.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,163.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,163.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,163.00
|
| 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 ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$22,326.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| 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 ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$9,602.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,920.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cigna of CA HMO |
$6,145.28
|
| Rate for Payer: Cigna of CA PPO |
$7,105.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,721.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,341.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,097.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,779.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,761.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,801.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$9,602.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,920.40 |
| Max. Negotiated Rate |
$8,161.70 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,721.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,840.80
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,097.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,665.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.80 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Adventist Health Commercial |
$308.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,080.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.60
|
| Rate for Payer: EPIC Health Plan Senior |
$617.60
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$980.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$910.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Adventist Health Commercial |
$308.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,021.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$387.40
|
| Rate for Payer: Blue Shield of California Commercial |
$650.02
|
| Rate for Payer: Blue Shield of California Commercial |
$985.07
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna of CA HMO |
$988.16
|
| Rate for Payer: Cigna of CA PPO |
$1,142.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,080.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$611.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$980.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$691.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$926.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$926.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$2,458.20 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,750.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,223.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,466.24
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,414.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,024.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,879.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,879.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$2,458.20 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,750.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,223.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,466.24
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,414.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,024.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
915353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.52 |
| Max. Negotiated Rate |
$1,167.05 |
| Rate for Payer: Adventist Health Commercial |
$562.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$755.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,029.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.08
|
| Rate for Payer: Blue Shield of California Commercial |
$696.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.84
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cigna of CA HMO |
$961.10
|
| Rate for Payer: Cigna of CA PPO |
$961.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,167.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,167.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$961.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$549.20
|
| Rate for Payer: Galaxy Health WC |
$1,167.05
|
| Rate for Payer: Global Benefits Group Commercial |
$823.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$871.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,064.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$810.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$961.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$961.10
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: Networks By Design Commercial |
$686.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$823.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$823.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,167.05
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
915353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$274.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cigna of CA HMO |
$961.10
|
| Rate for Payer: Cigna of CA PPO |
$961.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$961.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$549.20
|
| Rate for Payer: Galaxy Health WC |
$1,167.05
|
| Rate for Payer: Global Benefits Group Commercial |
$823.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$871.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$810.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.52
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: Networks By Design Commercial |
$892.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
|
