|
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 |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,173.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| 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/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,173.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,228.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,487.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| 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 |
$7,266.50
|
| 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 |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,733.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,610.70
|
| 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 |
$488.81 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.81
|
| 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 |
$1,751.84
|
| Rate for Payer: Cash Price |
$1,228.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,733.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$990.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,610.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,733.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,610.70
|
| 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 TTS BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.81 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.81
|
| 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 |
$1,751.84
|
| Rate for Payer: Cash Price |
$1,228.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,911.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,733.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$990.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,610.70
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| 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 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 |
$717.42
|
| Rate for Payer: Blue Shield of California Commercial |
$470.68
|
| Rate for Payer: Blue Shield of California Commercial |
$713.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| 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 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 |
$594.18 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$999.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,276.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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: 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 |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,496.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| 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/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,171.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,813.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| 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 |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,496.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,171.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,947.05
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,118.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,735.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,470.97
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,176.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$2,647.35
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,118.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$906.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,735.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,024.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,411.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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 |
$2,941.50
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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 |
$594.18 |
| Max. Negotiated Rate |
$52,103.30 |
| Rate for Payer: Adventist Health Commercial |
$12,259.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40,205.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,608.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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: 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 |
$42,913.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,469.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,608.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,908.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,204.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31,469.86
|
| 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/Senior |
$46,918.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,608.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38,924.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,251.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,052.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,711.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,047.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,336.01
|
| 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 |
$28,608.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,913.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,469.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28,608.96
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$42,908.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$38,924.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36,165.82
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,987.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,802.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,675.01
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$567.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,987.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| 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/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,204.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| 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 |
$1,419.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,087.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,795.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$7,192.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,274.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,795.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,805.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,912.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5,274.81
|
| 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/Senior |
$7,864.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$327.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,795.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,452.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,713.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,304.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,042.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,425.68
|
| 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 |
$2,718.50
|
| 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 |
$4,795.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,192.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,274.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4,795.28
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,805.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,452.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,207.83
|
| 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 CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
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 RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.83 |
| 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 |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,389.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| 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 |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,981.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| 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 |
$3,112.81
|
| 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 |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
901200090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.83 |
| 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 |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,389.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| 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 |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,981.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| 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 |
$3,112.81
|
| 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 |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
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: 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 RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$122.80
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$181.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$122.80
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$181.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.80
|
| Rate for Payer: EPIC Health Plan Senior |
$122.80
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$181.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$260.95 |
| Rate for Payer: Adventist Health Commercial |
$61.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.00
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cash Price |
$138.15
|
| Rate for Payer: Cigna of CA HMO |
$196.48
|
| Rate for Payer: Cigna of CA PPO |
$227.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$214.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$260.95
|
| Rate for Payer: Global Benefits Group Commercial |
$184.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$194.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Networks By Design Commercial |
$199.55
|
| Rate for Payer: Prime Health Services Commercial |
$260.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$184.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$184.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
