|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$5,343.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$4,541.55 |
| Rate for Payer: Adventist Health Commercial |
$1,068.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cash Price |
$2,404.35
|
| Rate for Payer: Cigna of CA HMO |
$3,419.52
|
| Rate for Payer: Cigna of CA PPO |
$3,953.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,740.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$4,541.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,205.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,392.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$4,274.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,472.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,541.55
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,205.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,671.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,671.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,671.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,671.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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 |
$1,130.70
|
| Rate for Payer: Blue Shield of California Commercial |
$947.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.49
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| 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 |
$1,214.20
|
| 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 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 |
$1,390.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,163.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,962.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,823.69
|
| 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 |
$9,104.00
|
| 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 |
$1,390.95
|
| Rate for Payer: Cash Price |
$1,390.95
|
| Rate for Payer: Cash Price |
$1,390.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,163.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,962.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$411.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,823.69
|
| 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 |
$1,545.50
|
| 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
|
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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$16,989.30
|
| Rate for Payer: Cash Price |
$16,989.30
|
| Rate for Payer: Cash Price |
$16,989.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,427.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23,973.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,274.86
|
| 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 |
$18,877.00
|
| 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
|
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 |
$16,989.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,427.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23,973.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,274.86
|
| 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
|
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 |
$16,989.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,427.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23,973.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,274.86
|
| 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 |
$592.94 |
| 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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$16,989.30
|
| Rate for Payer: Cash Price |
$16,989.30
|
| Rate for Payer: Cash Price |
$16,989.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,427.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23,973.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$670.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,274.86
|
| 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 |
$18,877.00
|
| 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 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 |
$13,421.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,877.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18,938.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,596.75
|
| 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 COMPLEX
|
Facility
|
OP
|
$29,825.00
|
|
|
Service Code
|
CPT 77763
|
| Hospital Charge Code |
909100403
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$895.78 |
| Max. Negotiated Rate |
$25,351.25 |
| Rate for Payer: Adventist Health Commercial |
$5,965.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,913.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,359.97
|
| Rate for Payer: Blue Shield of California Commercial |
$19,028.35
|
| Rate for Payer: Blue Shield of California Commercial |
$12,556.33
|
| Rate for Payer: Cash Price |
$13,421.25
|
| Rate for Payer: Cash Price |
$13,421.25
|
| Rate for Payer: Cash Price |
$13,421.25
|
| 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 |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,877.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| 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/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,013.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,938.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,146.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,158.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,128.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,200.35
|
| 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 |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
HC INTRACAVITARY INTER
|
Facility
|
OP
|
$36,195.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$710.66 |
| Max. Negotiated Rate |
$30,765.75 |
| Rate for Payer: Adventist Health Commercial |
$7,239.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,479.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.49
|
| Rate for Payer: Blue Shield of California Commercial |
$23,092.41
|
| Rate for Payer: Blue Shield of California Commercial |
$15,238.09
|
| Rate for Payer: Cash Price |
$16,287.75
|
| Rate for Payer: Cash Price |
$16,287.75
|
| 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 |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,336.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,172.59
|
| Rate for Payer: EPIC Health Plan Senior |
$781.73
|
| 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/Senior |
$1,165.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$718.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,983.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,686.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$895.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$952.28
|
| 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 |
$710.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
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 |
$16,287.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,336.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$22,983.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,355.05
|
| 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
|
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 |
$15,512.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,130.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21,889.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,338.48
|
| 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 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 |
$1,264.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$759.51
|
| Rate for Payer: Blue Shield of California Commercial |
$21,993.14
|
| Rate for Payer: Blue Shield of California Commercial |
$14,512.71
|
| Rate for Payer: Cash Price |
$15,512.40
|
| Rate for Payer: Cash Price |
$15,512.40
|
| 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 |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,130.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,172.59
|
| Rate for Payer: EPIC Health Plan Senior |
$781.73
|
| 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/Senior |
$1,165.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$541.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,889.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$612.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,273.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$895.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$952.28
|
| 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
|
| 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 |
$710.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$217.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$761.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$690.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$641.92
|
| 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 |
$544.00
|
| 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
|
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: Adventist Health Commercial |
$217.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$761.60
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$690.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$641.92
|
| 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
|
IP
|
$11,276.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,255.20 |
| Max. Negotiated Rate |
$9,584.60 |
| Rate for Payer: Adventist Health Commercial |
$2,255.20
|
| Rate for Payer: Cash Price |
$5,074.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,893.20
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,160.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,652.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.24
|
| 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
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,255.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$8,240.00
|
| 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 |
$5,074.20
|
| Rate for Payer: Cash Price |
$5,074.20
|
| Rate for Payer: Cash Price |
$5,074.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,893.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,160.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,258.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,652.84
|
| 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 |
$5,638.00
|
| 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
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
OP
|
$3,582.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,044.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,970.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,686.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cigna of CA HMO |
$2,292.48
|
| Rate for Payer: Cigna of CA PPO |
$2,650.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,044.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,044.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,044.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,507.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,432.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,432.80
|
| Rate for Payer: Galaxy Health WC |
$3,044.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,149.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$746.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,274.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$843.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,113.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,507.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,507.40
|
| Rate for Payer: Multiplan Commercial |
$2,865.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,044.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,149.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,791.00
|
| 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 |
$3,044.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,044.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,044.70
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
IP
|
$3,582.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$716.40 |
| Max. Negotiated Rate |
$3,044.70 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,507.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,432.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,432.80
|
| Rate for Payer: Galaxy Health WC |
$3,044.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,149.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,274.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,113.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.68
|
| Rate for Payer: Multiplan Commercial |
$2,865.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,044.70
|
|
|
HC INTRANASAL BX
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cigna of CA HMO |
$1,973.12
|
| Rate for Payer: Cigna of CA PPO |
$2,281.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,957.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,793.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,849.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,541.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC INTRANASAL BX
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$616.60 |
| Max. Negotiated Rate |
$2,620.55 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,233.20
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,957.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,818.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.92
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
|
|
HC INTRAOP NEURO TESTING, EA 15 MIN
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$45.44 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$427.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$583.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.24
|
| Rate for Payer: Blue Shield of California Commercial |
$496.36
|
| Rate for Payer: Blue Shield of California Commercial |
$327.54
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$497.92
|
| Rate for Payer: Cigna of CA PPO |
$575.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$661.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$661.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$544.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$544.60
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$661.30
|
| Rate for Payer: Vantage Medical Group Senior |
$661.30
|
|
|
HC INTRAOP NEURO TESTING, EA 15 MIN
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
|
