|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cash Price |
$147.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC MASTOID CHILD
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC MASTOID CHILD
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.69
|
| Rate for Payer: Blue Shield of California Commercial |
$495.11
|
| Rate for Payer: Blue Shield of California EPN |
$326.84
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$485.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC MASTOID COMPLETE
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC MASTOID COMPLETE
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.16
|
| Rate for Payer: Blue Shield of California Commercial |
$495.11
|
| Rate for Payer: Blue Shield of California EPN |
$326.84
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: Cash Price |
$444.95
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$485.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$8,182.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,500.10
|
| Rate for Payer: Cash Price |
$4,500.10
|
| Rate for Payer: Cash Price |
$4,500.10
|
| Rate for Payer: Cigna of CA HMO |
$5,236.48
|
| Rate for Payer: Cigna of CA PPO |
$6,054.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$6,954.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,909.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,457.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,963.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,545.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,318.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,954.70
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,909.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$8,182.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,636.40 |
| Max. Negotiated Rate |
$6,954.70 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Cash Price |
$4,500.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,272.80
|
| Rate for Payer: Galaxy Health WC |
$6,954.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,909.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,457.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,117.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,064.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,963.68
|
| Rate for Payer: Multiplan Commercial |
$6,545.60
|
| Rate for Payer: Networks By Design Commercial |
$5,318.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,954.70
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,278.75
|
| Rate for Payer: Cash Price |
$1,278.75
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,439.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
| Rate for Payer: Networks By Design Commercial |
$1,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$872.57
|
| Rate for Payer: United Healthcare All Other HMO |
$849.32
|
| Rate for Payer: United Healthcare HMO Rider |
$830.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.44
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
OP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,976.25 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,278.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,743.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,278.75
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,976.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,976.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,439.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,627.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,627.50
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
| Rate for Payer: Networks By Design Commercial |
$1,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,395.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,395.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$872.57
|
| Rate for Payer: United Healthcare All Other HMO |
$849.32
|
| Rate for Payer: United Healthcare HMO Rider |
$830.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,976.25
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
IP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,657.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$956.40
|
| Rate for Payer: Multiplan Commercial |
$3,188.00
|
| Rate for Payer: Networks By Design Commercial |
$1,992.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,495.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,455.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,424.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.09
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
OP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$3,387.25 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,191.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,988.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,308.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,940.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,936.71
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,387.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,657.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$956.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,789.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,789.50
|
| Rate for Payer: Multiplan Commercial |
$3,188.00
|
| Rate for Payer: Networks By Design Commercial |
$1,992.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,391.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,495.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,455.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,424.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$3,740.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,420.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,548.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,247.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,138.40
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,740.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,723.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,080.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,080.00
|
| Rate for Payer: Multiplan Commercial |
$3,520.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,640.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,640.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,651.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,607.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,572.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,740.00
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
IP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,723.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.00
|
| Rate for Payer: Multiplan Commercial |
$3,520.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,651.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,607.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,572.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,441.00
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
IP
|
$12,735.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,547.00 |
| Max. Negotiated Rate |
$10,824.75 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,094.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,094.00
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,852.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,882.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
OP
|
$12,735.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$12,326.96 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: Cigna of CA HMO |
$8,150.40
|
| Rate for Payer: Cigna of CA PPO |
$9,423.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,470.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,641.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,367.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,367.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,367.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,367.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC MEASLES AB
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.82
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC MEASLES AB
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$234.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cash Price |
$208.45
|
| Rate for Payer: Cigna of CA HMO |
$242.56
|
| Rate for Payer: Cigna of CA PPO |
$280.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$17,053.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,472.25
|
| 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 |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: Cigna of CA HMO |
$11,084.45
|
| Rate for Payer: Cigna of CA PPO |
$12,619.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,092.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$13,642.40
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,231.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,231.80
|
| 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: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$17,053.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,410.60 |
| Max. Negotiated Rate |
$14,495.05 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Cash Price |
$9,379.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,821.20
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,497.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,555.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,092.72
|
| Rate for Payer: Multiplan Commercial |
$13,642.40
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
OP
|
$14,829.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,106.49
|
| 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 |
$8,155.95
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: Cigna of CA HMO |
$9,638.85
|
| Rate for Payer: Cigna of CA PPO |
$10,973.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,558.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$11,863.20
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,897.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,897.40
|
| 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: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC MECH CORO THROMBECTOMY UNLIST
|
Facility
|
IP
|
$14,829.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820328
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.80 |
| Max. Negotiated Rate |
$12,604.65 |
| Rate for Payer: Adventist Health Commercial |
$2,965.80
|
| Rate for Payer: Cash Price |
$8,155.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,931.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,931.60
|
| Rate for Payer: Galaxy Health WC |
$12,604.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,897.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,890.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,649.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,179.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,558.96
|
| Rate for Payer: Multiplan Commercial |
$11,863.20
|
| Rate for Payer: Networks By Design Commercial |
$9,638.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,604.65
|
|
|
HC MECKELS SCAN
|
Facility
|
IP
|
$3,413.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.60 |
| Max. Negotiated Rate |
$2,901.05 |
| Rate for Payer: Adventist Health Commercial |
$682.60
|
| Rate for Payer: Cash Price |
$1,877.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,365.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,365.20
|
| Rate for Payer: Galaxy Health WC |
$2,901.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,047.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,276.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,300.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,112.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$819.12
|
| Rate for Payer: Multiplan Commercial |
$2,730.40
|
| Rate for Payer: Networks By Design Commercial |
$2,218.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,901.05
|
|
|
HC MECKELS SCAN
|
Facility
|
OP
|
$3,413.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
909301366
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$2,901.05 |
| Rate for Payer: Adventist Health Commercial |
$682.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,238.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,095.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2,088.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,378.85
|
| Rate for Payer: Cash Price |
$1,877.15
|
| Rate for Payer: Cash Price |
$1,877.15
|
| Rate for Payer: Cigna of CA HMO |
$2,184.32
|
| Rate for Payer: Cigna of CA PPO |
$2,525.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,901.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,047.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,276.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$819.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$2,730.40
|
| Rate for Payer: Networks By Design Commercial |
$2,218.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,901.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,047.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,047.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
