|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$92.97 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.21
|
| Rate for Payer: Blue Shield of California Commercial |
$55.46
|
| Rate for Payer: Blue Shield of California Commercial |
$84.11
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$71.10
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$71.10
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$92.97 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.21
|
| Rate for Payer: Blue Shield of California Commercial |
$55.46
|
| Rate for Payer: Blue Shield of California Commercial |
$84.11
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
OP
|
$5,927.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,259.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,445.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cigna of CA HMO |
$3,793.28
|
| Rate for Payer: Cigna of CA PPO |
$4,385.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,037.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,037.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,148.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,763.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,151.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,496.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,148.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,148.90
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,556.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,963.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,037.95
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
IP
|
$5,927.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$5,037.95 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,148.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,763.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,496.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
OP
|
$5,927.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,259.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,445.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cigna of CA HMO |
$3,793.28
|
| Rate for Payer: Cigna of CA PPO |
$4,385.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,037.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,037.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,148.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,763.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,151.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,496.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,148.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,148.90
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,556.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,963.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,037.95
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
IP
|
$5,927.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$5,037.95 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,148.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,763.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,496.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$35,043.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.68 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,008.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$15,769.35
|
| Rate for Payer: Cash Price |
$15,769.35
|
| Rate for Payer: Cash Price |
$15,769.35
|
| Rate for Payer: Cigna of CA HMO |
$22,427.52
|
| Rate for Payer: Cigna of CA PPO |
$25,931.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,530.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| Rate for Payer: Galaxy Health WC |
$29,786.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,025.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,252.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$474.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,410.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,223.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$28,034.40
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$22,777.95
|
| Rate for Payer: Prime Health Services Commercial |
$29,786.55
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,025.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,521.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$35,043.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,008.60 |
| Max. Negotiated Rate |
$29,786.55 |
| Rate for Payer: Adventist Health Commercial |
$7,008.60
|
| Rate for Payer: Cash Price |
$15,769.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,530.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,017.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,017.20
|
| Rate for Payer: Galaxy Health WC |
$29,786.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,025.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,252.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,675.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,410.32
|
| Rate for Payer: Multiplan Commercial |
$28,034.40
|
| Rate for Payer: Networks By Design Commercial |
$22,777.95
|
| Rate for Payer: Prime Health Services Commercial |
$29,786.55
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.24 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Adventist Health Commercial |
$749.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cigna of CA HMO |
$2,399.36
|
| Rate for Payer: Cigna of CA PPO |
$2,774.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,624.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,380.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,249.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,874.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,874.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,874.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,874.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC REVISION OF EYELID
|
Facility
|
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$749.80 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Adventist Health Commercial |
$749.80
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,624.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,499.60
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,380.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,211.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
OP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cigna of CA HMO |
$31,029.76
|
| Rate for Payer: Cigna of CA PPO |
$35,878.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,938.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,787.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,636.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$38,787.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,090.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
IP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,696.80 |
| Max. Negotiated Rate |
$41,211.40 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,938.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,393.60
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,787.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,605.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,636.16
|
| Rate for Payer: Multiplan Commercial |
$38,787.20
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV ATHER TIB ANGIO
|
Facility
|
IP
|
$58,944.00
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
906819793
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,788.80 |
| Max. Negotiated Rate |
$50,102.40 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23,577.60
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,776.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,146.56
|
| Rate for Payer: Multiplan Commercial |
$47,155.20
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV ATHER TIB ANGIO
|
Facility
|
OP
|
$58,944.00
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
906819793
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cigna of CA HMO |
$37,724.16
|
| Rate for Payer: Cigna of CA PPO |
$43,618.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,146.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$47,155.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,366.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,472.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV STNT TIB ANGIO
|
Facility
|
OP
|
$58,944.00
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
906819792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cigna of CA HMO |
$37,724.16
|
| Rate for Payer: Cigna of CA PPO |
$43,618.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,146.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$47,155.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,366.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,472.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV STNT TIB ANGIO
|
Facility
|
IP
|
$58,944.00
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
906819792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,788.80 |
| Max. Negotiated Rate |
$50,102.40 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23,577.60
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,776.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,146.56
|
| Rate for Payer: Multiplan Commercial |
$47,155.20
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV TIB ANGIO
|
Facility
|
IP
|
$37,119.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
906819791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,423.80 |
| Max. Negotiated Rate |
$31,551.15 |
| Rate for Payer: Adventist Health Commercial |
$7,423.80
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,983.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,847.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,847.60
|
| Rate for Payer: Galaxy Health WC |
$31,551.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,271.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,570.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,900.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,908.56
|
| Rate for Payer: Multiplan Commercial |
$29,695.20
|
| Rate for Payer: Networks By Design Commercial |
$24,127.35
|
| Rate for Payer: Prime Health Services Commercial |
$31,551.15
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV TIB ANGIO
|
Facility
|
OP
|
$37,119.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
906819791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,423.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Cigna of CA HMO |
$23,756.16
|
| Rate for Payer: Cigna of CA PPO |
$27,468.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,983.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$31,551.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,271.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,570.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,908.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$29,695.20
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$24,127.35
|
| Rate for Payer: Prime Health Services Commercial |
$31,551.15
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,271.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,559.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$766.82 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cigna of CA HMO |
$4,012.80
|
| Rate for Payer: Cigna of CA PPO |
$4,639.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,389.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$766.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,981.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$867.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,762.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,135.00
|
| 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 |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,389.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,981.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,699.30
|
| 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
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$1,872.55 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,542.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,299.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,211.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,652.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cigna of CA HMO |
$1,409.92
|
| Rate for Payer: Cigna of CA PPO |
$1,630.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,872.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,542.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,299.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,542.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,542.10
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,321.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,101.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,872.55
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$1,872.55 |
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,542.10
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,299.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
|
