|
HC PREVIEW TRT PLANNING
|
Facility
|
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$1,964.35 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Cash Price |
$1,271.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,271.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,733.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,419.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.33
|
| Rate for Payer: Blue Shield of California EPN |
$933.64
|
| Rate for Payer: Cash Price |
$1,271.05
|
| Rate for Payer: Cash Price |
$1,271.05
|
| Rate for Payer: Cigna of CA HMO |
$1,479.04
|
| Rate for Payer: Cigna of CA PPO |
$1,710.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,964.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.70
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,964.35
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908603033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908603033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.78
|
| Rate for Payer: Blue Shield of California Commercial |
$68.54
|
| Rate for Payer: Blue Shield of California EPN |
$45.25
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$118.15 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$76.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Senior |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.36
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.36
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$76.45
|
| Rate for Payer: Cash Price |
$76.45
|
| Rate for Payer: Cash Price |
$76.45
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$680.50 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| 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 |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| 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 |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$680.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,092.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| 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 |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
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 PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$680.50 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: Cigna of CA HMO |
$6,330.24
|
| Rate for Payer: Cigna of CA PPO |
$7,319.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$680.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,934.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,978.20 |
| Max. Negotiated Rate |
$8,407.35 |
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,956.40
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,768.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,122.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$680.50 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: Cigna of CA HMO |
$6,429.15
|
| Rate for Payer: Cigna of CA PPO |
$7,319.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$680.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,934.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,934.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,978.20 |
| Max. Negotiated Rate |
$8,407.35 |
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: Cash Price |
$5,440.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,956.40
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,768.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,122.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,864.00 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,455.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,436.80
|
| Rate for Payer: Multiplan Commercial |
$11,456.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,876.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,740.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cigna of CA HMO |
$9,164.80
|
| Rate for Payer: Cigna of CA PPO |
$10,596.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,172.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,440.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,436.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,024.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,024.00
|
| Rate for Payer: Multiplan Commercial |
$11,456.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,592.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,172.00
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$8,306.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,568.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,229.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,568.30
|
| Rate for Payer: Cash Price |
$4,568.30
|
| Rate for Payer: Cash Price |
$4,568.30
|
| Rate for Payer: Cigna of CA HMO |
$5,315.84
|
| Rate for Payer: Cigna of CA PPO |
$6,146.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,060.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,060.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,440.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,141.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,814.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,814.20
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,060.10
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$8,306.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,661.20 |
| Max. Negotiated Rate |
$7,060.10 |
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Cash Price |
$4,568.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,164.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,141.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
|
|
HC PRIMOBOOT BARIATRIC PRPL/NAVY
|
Facility
|
OP
|
$297.29
|
|
| Hospital Charge Code |
901698652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Adventist Health Commercial |
$59.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.57
|
| Rate for Payer: Cash Price |
$163.51
|
| Rate for Payer: Cigna of CA HMO |
$190.27
|
| Rate for Payer: Cigna of CA PPO |
$219.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.92
|
| Rate for Payer: EPIC Health Plan Senior |
$118.92
|
| Rate for Payer: Galaxy Health WC |
$252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$178.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$237.83
|
| Rate for Payer: Networks By Design Commercial |
$193.24
|
| Rate for Payer: Prime Health Services Commercial |
$252.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.65
|
| Rate for Payer: United Healthcare All Other HMO |
$148.65
|
| Rate for Payer: United Healthcare HMO Rider |
$148.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.70
|
| Rate for Payer: Vantage Medical Group Senior |
$252.70
|
|
|
HC PRIMOBOOT BARIATRIC PRPL/NAVY
|
Facility
|
IP
|
$297.29
|
|
| Hospital Charge Code |
901698652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Adventist Health Commercial |
$59.46
|
| Rate for Payer: Cash Price |
$163.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.92
|
| Rate for Payer: EPIC Health Plan Senior |
$118.92
|
| Rate for Payer: Galaxy Health WC |
$252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$178.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.35
|
| Rate for Payer: Multiplan Commercial |
$237.83
|
| Rate for Payer: Networks By Design Commercial |
$193.24
|
| Rate for Payer: Prime Health Services Commercial |
$252.70
|
|
|
HC PRIMOBOOT STD PURPLE/NAVY
|
Facility
|
OP
|
$268.17
|
|
| Hospital Charge Code |
901698653
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$227.94 |
| Rate for Payer: Adventist Health Commercial |
$53.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.68
|
| Rate for Payer: Cash Price |
$147.49
|
| Rate for Payer: Cigna of CA HMO |
$171.63
|
| Rate for Payer: Cigna of CA PPO |
$198.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.27
|
| Rate for Payer: EPIC Health Plan Senior |
$107.27
|
| Rate for Payer: Galaxy Health WC |
$227.94
|
| Rate for Payer: Global Benefits Group Commercial |
$160.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.72
|
| Rate for Payer: Multiplan Commercial |
$214.54
|
| Rate for Payer: Networks By Design Commercial |
$174.31
|
| Rate for Payer: Prime Health Services Commercial |
$227.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.09
|
| Rate for Payer: United Healthcare All Other HMO |
$134.09
|
| Rate for Payer: United Healthcare HMO Rider |
$134.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.94
|
| Rate for Payer: Vantage Medical Group Senior |
$227.94
|
|
|
HC PRIMOBOOT STD PURPLE/NAVY
|
Facility
|
IP
|
$268.17
|
|
| Hospital Charge Code |
901698653
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$227.94 |
| Rate for Payer: Adventist Health Commercial |
$53.63
|
| Rate for Payer: Cash Price |
$147.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.27
|
| Rate for Payer: EPIC Health Plan Senior |
$107.27
|
| Rate for Payer: Galaxy Health WC |
$227.94
|
| Rate for Payer: Global Benefits Group Commercial |
$160.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.36
|
| Rate for Payer: Multiplan Commercial |
$214.54
|
| Rate for Payer: Networks By Design Commercial |
$174.31
|
| Rate for Payer: Prime Health Services Commercial |
$227.94
|
|
|
HC PRIMOBOOT STD W/WEDGE PUR/NAVY
|
Facility
|
OP
|
$297.22
|
|
| Hospital Charge Code |
901698678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$252.64 |
| Rate for Payer: Adventist Health Commercial |
$59.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.52
|
| Rate for Payer: Cash Price |
$163.47
|
| Rate for Payer: Cigna of CA HMO |
$190.22
|
| Rate for Payer: Cigna of CA PPO |
$219.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Senior |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.64
|
| Rate for Payer: Global Benefits Group Commercial |
$178.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.05
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.19
|
| Rate for Payer: Prime Health Services Commercial |
$252.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.61
|
| Rate for Payer: United Healthcare All Other HMO |
$148.61
|
| Rate for Payer: United Healthcare HMO Rider |
$148.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.64
|
| Rate for Payer: Vantage Medical Group Senior |
$252.64
|
|
|
HC PRIMOBOOT STD W/WEDGE PUR/NAVY
|
Facility
|
IP
|
$297.22
|
|
| Hospital Charge Code |
901698678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$252.64 |
| Rate for Payer: Adventist Health Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$163.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Senior |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.64
|
| Rate for Payer: Global Benefits Group Commercial |
$178.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.33
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.19
|
| Rate for Payer: Prime Health Services Commercial |
$252.64
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
OP
|
$3,599.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.91 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$719.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,979.45
|
| Rate for Payer: Cash Price |
$1,979.45
|
| Rate for Payer: Cash Price |
$1,979.45
|
| Rate for Payer: Cigna of CA HMO |
$2,303.36
|
| Rate for Payer: Cigna of CA PPO |
$2,663.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$3,059.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,159.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,400.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$2,879.20
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$2,339.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,059.15
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,159.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,799.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,799.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,799.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,799.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
