|
HC RIBS BILATERAL
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.00
|
| Rate for Payer: EPIC Health Plan Senior |
$444.00
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$740.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.40
|
| Rate for Payer: Multiplan Commercial |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
|
|
HC RIBS BILATERAL
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.96 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$728.05
|
| 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 |
$223.23
|
| Rate for Payer: Blue Shield of California Commercial |
$679.32
|
| Rate for Payer: Blue Shield of California EPN |
$448.44
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna of CA HMO |
$710.40
|
| Rate for Payer: Cigna of CA PPO |
$821.40
|
| 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 |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$740.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.40
|
| 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 |
$888.00
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$666.00
|
| 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 RIBS UNILATERAL
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$571.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.99
|
| Rate for Payer: Blue Shield of California Commercial |
$533.66
|
| Rate for Payer: Blue Shield of California EPN |
$352.29
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna of CA HMO |
$558.08
|
| Rate for Payer: Cigna of CA PPO |
$645.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$523.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$523.20
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC RIBS UNILATERAL
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$741.20 |
| Rate for Payer: Adventist Health Commercial |
$174.40
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$348.80
|
| Rate for Payer: Galaxy Health WC |
$741.20
|
| Rate for Payer: Global Benefits Group Commercial |
$523.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$581.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$539.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.28
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Networks By Design Commercial |
$566.80
|
| Rate for Payer: Prime Health Services Commercial |
$741.20
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$14,533.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,173.70 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,906.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$5,510.17
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: Cigna of CA HMO |
$9,446.45
|
| Rate for Payer: Cigna of CA PPO |
$10,754.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$12,353.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,719.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,173.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,693.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,487.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$11,626.40
|
| Rate for Payer: Networks By Design Commercial |
$9,446.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,353.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,719.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$14,533.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,906.60 |
| Max. Negotiated Rate |
$12,353.05 |
| Rate for Payer: Adventist Health Commercial |
$2,906.60
|
| Rate for Payer: Cash Price |
$6,539.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,813.20
|
| Rate for Payer: Galaxy Health WC |
$12,353.05
|
| Rate for Payer: Global Benefits Group Commercial |
$8,719.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,693.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,995.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,487.92
|
| Rate for Payer: Multiplan Commercial |
$11,626.40
|
| Rate for Payer: Networks By Design Commercial |
$9,446.45
|
| Rate for Payer: Prime Health Services Commercial |
$12,353.05
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$14,125.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,825.00 |
| Max. Negotiated Rate |
$12,006.25 |
| Rate for Payer: Adventist Health Commercial |
$2,825.00
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,650.00
|
| Rate for Payer: Galaxy Health WC |
$12,006.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,421.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,381.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,743.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,390.00
|
| Rate for Payer: Multiplan Commercial |
$11,300.00
|
| Rate for Payer: Networks By Design Commercial |
$9,181.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,006.25
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$14,125.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,173.70 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,825.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$5,510.17
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: Cigna of CA HMO |
$9,181.25
|
| Rate for Payer: Cigna of CA PPO |
$10,452.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$12,006.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,475.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,173.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,421.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,390.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$11,300.00
|
| Rate for Payer: Networks By Design Commercial |
$9,181.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,006.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RIGIFLEX OTW BALLOON DILATOR
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$2,184.00
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
|
|
HC RIGIFLEX OTW BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,790.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,676.49
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cigna of CA HMO |
$1,747.20
|
| Rate for Payer: Cigna of CA PPO |
$2,020.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,184.00
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,365.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,365.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,790.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,676.49
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cigna of CA HMO |
$1,747.20
|
| Rate for Payer: Cigna of CA PPO |
$2,020.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,184.00
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,365.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,365.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$2,184.00
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
OP
|
$1,118.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$733.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$686.56
|
| Rate for Payer: Blue Shield of California Commercial |
$684.22
|
| Rate for Payer: Blue Shield of California EPN |
$451.67
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$782.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$559.00
|
| Rate for Payer: United Healthcare HMO Rider |
$559.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$559.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
IP
|
$1,118.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC RLCJ SKIN POCKET CCM DFIB PG
|
Facility
|
IP
|
$4,995.00
|
|
|
Service Code
|
CPT 0925T
|
| Hospital Charge Code |
906811513
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$999.00 |
| Max. Negotiated Rate |
$4,245.75 |
| Rate for Payer: Adventist Health Commercial |
$999.00
|
| Rate for Payer: Cash Price |
$2,247.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,998.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,998.00
|
| Rate for Payer: Galaxy Health WC |
$4,245.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,997.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,331.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,903.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,091.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.80
|
| Rate for Payer: Multiplan Commercial |
$3,996.00
|
| Rate for Payer: Networks By Design Commercial |
$3,246.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,245.75
|
|
|
HC RLCJ SKIN POCKET CCM DFIB PG
|
Facility
|
OP
|
$4,995.00
|
|
|
Service Code
|
CPT 0925T
|
| Hospital Charge Code |
906811513
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$999.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,067.43
|
| 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 |
$2,247.75
|
| Rate for Payer: Cash Price |
$2,247.75
|
| Rate for Payer: Cash Price |
$2,247.75
|
| Rate for Payer: Cigna of CA HMO |
$3,196.80
|
| Rate for Payer: Cigna of CA PPO |
$3,696.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$4,245.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,997.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,331.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,903.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,996.00
|
| Rate for Payer: Networks By Design Commercial |
$3,246.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,245.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,997.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,997.00
|
| 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 |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
IP
|
$5,883.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,176.60 |
| Max. Negotiated Rate |
$5,000.55 |
| Rate for Payer: Adventist Health Commercial |
$1,176.60
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,353.20
|
| Rate for Payer: Galaxy Health WC |
$5,000.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,529.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,923.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,241.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,641.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.92
|
| Rate for Payer: Multiplan Commercial |
$4,706.40
|
| Rate for Payer: Networks By Design Commercial |
$3,823.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,000.55
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
OP
|
$5,883.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.29 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,176.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| 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 |
$2,647.35
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Cigna of CA HMO |
$3,765.12
|
| Rate for Payer: Cigna of CA PPO |
$4,353.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$5,000.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,529.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$906.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,923.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$4,706.40
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$3,823.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,000.55
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,529.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC RMVL AND RPLCMT PERM CCM DFIB PG
|
Facility
|
OP
|
$61,298.00
|
|
|
Service Code
|
CPT 0923T
|
| Hospital Charge Code |
906811511
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$52,103.30 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,643.10
|
| 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 |
$27,584.10
|
| Rate for Payer: Cash Price |
$27,584.10
|
| Rate for Payer: Cash Price |
$27,584.10
|
| Rate for Payer: Cigna of CA HMO |
$39,230.72
|
| Rate for Payer: Cigna of CA PPO |
$45,360.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,502.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28,520.13
|
| Rate for Payer: Galaxy Health WC |
$52,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$36,778.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,773.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,885.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,354.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,520.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,711.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,216.97
|
| Rate for Payer: Multiplan Commercial |
$49,038.40
|
| Rate for Payer: Networks By Design Commercial |
$39,843.70
|
| Rate for Payer: Prime Health Services Commercial |
$52,103.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,778.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36,778.80
|
| 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 |
$28,520.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC RMVL AND RPLCMT PERM CCM DFIB PG
|
Facility
|
IP
|
$61,298.00
|
|
|
Service Code
|
CPT 0923T
|
| Hospital Charge Code |
906811511
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12,259.60 |
| Max. Negotiated Rate |
$52,103.30 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Cash Price |
$27,584.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$24,519.20
|
| Rate for Payer: Galaxy Health WC |
$52,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$36,778.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40,885.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,354.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,943.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,711.52
|
| Rate for Payer: Multiplan Commercial |
$49,038.40
|
| Rate for Payer: Networks By Design Commercial |
$39,843.70
|
| Rate for Payer: Prime Health Services Commercial |
$52,103.30
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
IP
|
$2,839.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.80 |
| Max. Negotiated Rate |
$2,413.15 |
| Rate for Payer: Adventist Health Commercial |
$567.80
|
| Rate for Payer: Cash Price |
$1,277.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.60
|
| Rate for Payer: Galaxy Health WC |
$2,413.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,703.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,893.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,757.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.36
|
| Rate for Payer: Multiplan Commercial |
$2,271.20
|
| Rate for Payer: Networks By Design Commercial |
$1,845.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,413.15
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
OP
|
$2,839.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.82 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$567.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,277.55
|
| Rate for Payer: Cash Price |
$1,277.55
|
| Rate for Payer: Cash Price |
$1,277.55
|
| Rate for Payer: Cigna of CA HMO |
$1,816.96
|
| Rate for Payer: Cigna of CA PPO |
$2,100.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$2,413.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,703.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,893.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$2,271.20
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$1,845.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,413.15
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,703.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
IP
|
$5,437.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,087.40 |
| Max. Negotiated Rate |
$4,621.45 |
| Rate for Payer: Adventist Health Commercial |
$1,087.40
|
| Rate for Payer: Cash Price |
$2,446.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,174.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,174.80
|
| Rate for Payer: Galaxy Health WC |
$4,621.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,626.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,071.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,365.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.88
|
| Rate for Payer: Multiplan Commercial |
$4,349.60
|
| Rate for Payer: Networks By Design Commercial |
$3,534.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,621.45
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
OP
|
$5,437.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$327.75 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,087.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,446.65
|
| Rate for Payer: Cash Price |
$2,446.65
|
| Rate for Payer: Cash Price |
$2,446.65
|
| Rate for Payer: Cigna of CA HMO |
$3,479.68
|
| Rate for Payer: Cigna of CA PPO |
$4,023.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,324.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4,684.64
|
| Rate for Payer: Galaxy Health WC |
$4,621.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,682.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$327.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,626.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,684.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,277.42
|
| Rate for Payer: Multiplan Commercial |
$4,349.60
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: Networks By Design Commercial |
$3,534.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,621.45
|
| Rate for Payer: Prime Health Services WC |
$7,387.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,684.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$5,329.50 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,508.00
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,881.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
|
