|
HC INTL CUSTM CONG/ATYP INSERT
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915340558
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
|
|
HC INTL CUSTM CONG/ATYP INSERT
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915340558
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$448.32 |
| Max. Negotiated Rate |
$1,587.80 |
| Rate for Payer: Adventist Health Commercial |
$765.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,081.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,378.58
|
| Rate for Payer: Blue Shield of California EPN |
$907.85
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,587.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,587.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,307.60
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,587.80
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.02 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,652.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,253.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,652.20
|
| Rate for Payer: Cash Price |
$1,652.20
|
| Rate for Payer: Cash Price |
$1,652.20
|
| Rate for Payer: Cigna of CA HMO |
$1,922.56
|
| Rate for Payer: Cigna of CA PPO |
$2,222.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,553.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.60
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,859.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.80
|
| Rate for Payer: Multiplan Commercial |
$2,403.20
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,802.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,553.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,553.40
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$3,004.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.80 |
| Max. Negotiated Rate |
$2,553.40 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Cash Price |
$1,652.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.60
|
| Rate for Payer: Galaxy Health WC |
$2,553.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,802.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,859.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.96
|
| Rate for Payer: Multiplan Commercial |
$2,403.20
|
| Rate for Payer: Networks By Design Commercial |
$1,952.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,553.40
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$3,091.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$618.20 |
| Max. Negotiated Rate |
$2,627.35 |
| Rate for Payer: Adventist Health Commercial |
$618.20
|
| Rate for Payer: Cash Price |
$1,700.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,236.40
|
| Rate for Payer: Galaxy Health WC |
$2,627.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,854.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,061.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,177.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,913.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.84
|
| Rate for Payer: Multiplan Commercial |
$2,472.80
|
| Rate for Payer: Networks By Design Commercial |
$2,009.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,627.35
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$3,091.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.02 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$618.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,627.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,700.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,318.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,700.05
|
| Rate for Payer: Cash Price |
$1,700.05
|
| Rate for Payer: Cash Price |
$1,700.05
|
| Rate for Payer: Cigna of CA HMO |
$1,978.24
|
| Rate for Payer: Cigna of CA PPO |
$2,287.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,627.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,627.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,627.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,236.40
|
| Rate for Payer: Galaxy Health WC |
$2,627.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,854.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,061.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,913.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,163.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,163.70
|
| Rate for Payer: Multiplan Commercial |
$2,472.80
|
| Rate for Payer: Networks By Design Commercial |
$2,009.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,627.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,854.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,866.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,627.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,627.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,627.35
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$37,754.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,550.80 |
| Max. Negotiated Rate |
$32,090.90 |
| Rate for Payer: Adventist Health Commercial |
$7,550.80
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,101.60
|
| Rate for Payer: Galaxy Health WC |
$32,090.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,181.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,384.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,369.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,060.96
|
| Rate for Payer: Multiplan Commercial |
$30,203.20
|
| Rate for Payer: Networks By Design Commercial |
$24,540.10
|
| Rate for Payer: Prime Health Services Commercial |
$32,090.90
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
OP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$298.97 |
| Max. Negotiated Rate |
$31,188.20 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,180.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,519.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cigna of CA HMO |
$23,482.88
|
| Rate for Payer: Cigna of CA PPO |
$27,152.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,188.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,676.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,676.80
|
| Rate for Payer: Galaxy Health WC |
$31,188.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,015.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,806.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,684.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,684.40
|
| Rate for Payer: Multiplan Commercial |
$29,353.60
|
| Rate for Payer: Networks By Design Commercial |
$23,849.80
|
| Rate for Payer: Prime Health Services Commercial |
$31,188.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,015.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31,188.20
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,338.40 |
| Max. Negotiated Rate |
$31,188.20 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,676.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,676.80
|
| Rate for Payer: Galaxy Health WC |
$31,188.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,015.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,979.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,806.08
|
| Rate for Payer: Multiplan Commercial |
$29,353.60
|
| Rate for Payer: Networks By Design Commercial |
$23,849.80
|
| Rate for Payer: Prime Health Services Commercial |
$31,188.20
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
OP
|
$37,754.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$298.97 |
| Max. Negotiated Rate |
$32,090.90 |
| Rate for Payer: Adventist Health Commercial |
$7,550.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,090.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,764.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,315.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: Cigna of CA HMO |
$24,162.56
|
| Rate for Payer: Cigna of CA PPO |
$27,937.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,090.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,090.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,090.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,101.60
|
| Rate for Payer: Galaxy Health WC |
$32,090.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,652.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,181.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,369.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,060.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,427.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,427.80
|
| Rate for Payer: Multiplan Commercial |
$30,203.20
|
| Rate for Payer: Networks By Design Commercial |
$24,540.10
|
| Rate for Payer: Prime Health Services Commercial |
$32,090.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$32,090.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,090.90
|
| Rate for Payer: Vantage Medical Group Senior |
$32,090.90
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
IP
|
$37,754.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,550.80 |
| Max. Negotiated Rate |
$32,090.90 |
| Rate for Payer: Adventist Health Commercial |
$7,550.80
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,101.60
|
| Rate for Payer: Galaxy Health WC |
$32,090.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,181.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,384.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,369.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,060.96
|
| Rate for Payer: Multiplan Commercial |
$30,203.20
|
| Rate for Payer: Networks By Design Commercial |
$24,540.10
|
| Rate for Payer: Prime Health Services Commercial |
$32,090.90
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$37,754.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$32,090.90 |
| Rate for Payer: Adventist Health Commercial |
$7,550.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,090.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,764.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,315.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: Cash Price |
$20,764.70
|
| Rate for Payer: Cigna of CA HMO |
$24,162.56
|
| Rate for Payer: Cigna of CA PPO |
$27,937.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,090.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,090.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,090.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,101.60
|
| Rate for Payer: Galaxy Health WC |
$32,090.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,652.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$592.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,181.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,369.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,060.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,427.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,427.80
|
| Rate for Payer: Multiplan Commercial |
$30,203.20
|
| Rate for Payer: Networks By Design Commercial |
$24,540.10
|
| Rate for Payer: Prime Health Services Commercial |
$32,090.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$32,090.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,090.90
|
| Rate for Payer: Vantage Medical Group Senior |
$32,090.90
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$36,692.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$31,188.20 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,180.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,519.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cigna of CA HMO |
$23,482.88
|
| Rate for Payer: Cigna of CA PPO |
$27,152.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,188.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,676.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,676.80
|
| Rate for Payer: Galaxy Health WC |
$31,188.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,015.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$592.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,806.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,684.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,684.40
|
| Rate for Payer: Multiplan Commercial |
$29,353.60
|
| Rate for Payer: Networks By Design Commercial |
$23,849.80
|
| Rate for Payer: Prime Health Services Commercial |
$31,188.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,015.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31,188.20
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
IP
|
$36,692.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,338.40 |
| Max. Negotiated Rate |
$31,188.20 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,676.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,676.80
|
| Rate for Payer: Galaxy Health WC |
$31,188.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,015.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,979.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,806.08
|
| Rate for Payer: Multiplan Commercial |
$29,353.60
|
| Rate for Payer: Networks By Design Commercial |
$23,849.80
|
| Rate for Payer: Prime Health Services Commercial |
$31,188.20
|
|
|
HC INTRACAVITARY COMPLEX
|
Facility
|
OP
|
$29,825.00
|
|
|
Service Code
|
CPT 77763
|
| Hospital Charge Code |
909100403
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$881.55 |
| Max. Negotiated Rate |
$25,351.25 |
| Rate for Payer: Adventist Health Commercial |
$5,965.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19,562.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,301.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18,252.90
|
| Rate for Payer: Blue Shield of California EPN |
$12,049.30
|
| Rate for Payer: Cash Price |
$16,403.75
|
| Rate for Payer: Cash Price |
$16,403.75
|
| Rate for Payer: Cash Price |
$16,403.75
|
| Rate for Payer: Cigna of CA HMO |
$19,088.00
|
| Rate for Payer: Cigna of CA PPO |
$22,070.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$25,351.25
|
| Rate for Payer: Global Benefits Group Commercial |
$17,895.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,013.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,893.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,158.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$23,860.00
|
| Rate for Payer: Networks By Design Commercial |
$19,386.25
|
| Rate for Payer: Prime Health Services Commercial |
$25,351.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,895.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC INTRACAVITARY COMPLEX
|
Facility
|
IP
|
$29,825.00
|
|
|
Service Code
|
CPT 77763
|
| Hospital Charge Code |
909100403
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,965.00 |
| Max. Negotiated Rate |
$25,351.25 |
| Rate for Payer: Adventist Health Commercial |
$5,965.00
|
| Rate for Payer: Cash Price |
$16,403.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,930.00
|
| Rate for Payer: Galaxy Health WC |
$25,351.25
|
| Rate for Payer: Global Benefits Group Commercial |
$17,895.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,893.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,363.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,461.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,158.00
|
| Rate for Payer: Multiplan Commercial |
$23,860.00
|
| Rate for Payer: Networks By Design Commercial |
$19,386.25
|
| Rate for Payer: Prime Health Services Commercial |
$25,351.25
|
|
|
HC INTRACAVITARY INTER
|
Facility
|
OP
|
$36,195.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$718.07 |
| Max. Negotiated Rate |
$30,765.75 |
| Rate for Payer: Adventist Health Commercial |
$7,239.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23,740.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,043.54
|
| Rate for Payer: Blue Shield of California Commercial |
$22,151.34
|
| Rate for Payer: Blue Shield of California EPN |
$14,622.78
|
| Rate for Payer: Cash Price |
$19,907.25
|
| Rate for Payer: Cash Price |
$19,907.25
|
| Rate for Payer: Cigna of CA HMO |
$23,164.80
|
| Rate for Payer: Cigna of CA PPO |
$26,784.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$30,765.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21,717.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$718.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,142.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,686.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$28,956.00
|
| Rate for Payer: Networks By Design Commercial |
$23,526.75
|
| Rate for Payer: Prime Health Services Commercial |
$30,765.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,717.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,717.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,097.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18,097.50
|
| Rate for Payer: United Healthcare HMO Rider |
$18,097.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,097.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC INTRACAVITARY INTER
|
Facility
|
IP
|
$36,195.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$7,239.00 |
| Max. Negotiated Rate |
$30,765.75 |
| Rate for Payer: Adventist Health Commercial |
$7,239.00
|
| Rate for Payer: Cash Price |
$19,907.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,478.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,478.00
|
| Rate for Payer: Galaxy Health WC |
$30,765.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21,717.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,142.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,790.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,404.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,686.80
|
| Rate for Payer: Multiplan Commercial |
$28,956.00
|
| Rate for Payer: Networks By Design Commercial |
$23,526.75
|
| Rate for Payer: Prime Health Services Commercial |
$30,765.75
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
OP
|
$34,472.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$541.77 |
| Max. Negotiated Rate |
$29,301.20 |
| Rate for Payer: Adventist Health Commercial |
$6,894.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22,610.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$726.81
|
| Rate for Payer: Blue Shield of California Commercial |
$21,096.86
|
| Rate for Payer: Blue Shield of California EPN |
$13,926.69
|
| Rate for Payer: Cash Price |
$18,959.60
|
| Rate for Payer: Cash Price |
$18,959.60
|
| Rate for Payer: Cigna of CA HMO |
$22,062.08
|
| Rate for Payer: Cigna of CA PPO |
$25,509.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$29,301.20
|
| Rate for Payer: Global Benefits Group Commercial |
$20,683.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$541.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,992.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,273.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$27,577.60
|
| Rate for Payer: Networks By Design Commercial |
$22,406.80
|
| Rate for Payer: Prime Health Services Commercial |
$29,301.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,683.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,683.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,236.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17,236.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,236.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,236.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
IP
|
$34,472.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$6,894.40 |
| Max. Negotiated Rate |
$29,301.20 |
| Rate for Payer: Adventist Health Commercial |
$6,894.40
|
| Rate for Payer: Cash Price |
$18,959.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,788.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,788.80
|
| Rate for Payer: Galaxy Health WC |
$29,301.20
|
| Rate for Payer: Global Benefits Group Commercial |
$20,683.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,992.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,133.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,338.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,273.28
|
| Rate for Payer: Multiplan Commercial |
$27,577.60
|
| Rate for Payer: Networks By Design Commercial |
$22,406.80
|
| Rate for Payer: Prime Health Services Commercial |
$29,301.20
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$217.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$924.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cigna of CA HMO |
$696.32
|
| Rate for Payer: Cigna of CA PPO |
$805.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$924.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$924.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$924.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.20
|
| Rate for Payer: EPIC Health Plan Senior |
$435.20
|
| Rate for Payer: Galaxy Health WC |
$924.80
|
| Rate for Payer: Global Benefits Group Commercial |
$652.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$673.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$761.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$761.60
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: Networks By Design Commercial |
$707.20
|
| Rate for Payer: Prime Health Services Commercial |
$924.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$652.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$924.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$924.80
|
| Rate for Payer: Vantage Medical Group Senior |
$924.80
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$942.08
|
| Rate for Payer: Cigna of CA PPO |
$1,089.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,030.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,251.20 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$924.80 |
| Rate for Payer: Galaxy Health WC |
$924.80
|
| Rate for Payer: Adventist Health Commercial |
$217.60
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.20
|
| Rate for Payer: EPIC Health Plan Senior |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$652.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$673.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.12
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: Networks By Design Commercial |
$707.20
|
| Rate for Payer: Prime Health Services Commercial |
$924.80
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
OP
|
$11,276.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,112.70 |
| Max. Negotiated Rate |
$13,494.00 |
| Rate for Payer: Adventist Health Commercial |
$2,255.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,584.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,201.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,457.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,201.80
|
| Rate for Payer: Cash Price |
$6,201.80
|
| Rate for Payer: Cash Price |
$6,201.80
|
| Rate for Payer: Cigna of CA HMO |
$7,216.64
|
| Rate for Payer: Cigna of CA PPO |
$8,344.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,584.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,584.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,584.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,510.40
|
| Rate for Payer: Galaxy Health WC |
$9,584.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,765.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,112.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,979.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,893.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,893.20
|
| Rate for Payer: Multiplan Commercial |
$9,020.80
|
| Rate for Payer: Networks By Design Commercial |
$7,329.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,584.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,765.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$9,584.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,584.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9,584.60
|
|
