|
HC BALLOON HYPERFORM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909020050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BALLOON NANOCROSS
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$626.13
|
| Rate for Payer: Blue Shield of California EPN |
$408.24
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$567.00
|
| Rate for Payer: Cigna of CA PPO |
$567.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$501.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$405.00
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.99
|
| Rate for Payer: United Healthcare All Other HMO |
$295.89
|
| Rate for Payer: United Healthcare HMO Rider |
$289.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.27
|
|
|
HC BALLOON NANOCROSS
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$445.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.50
|
| Rate for Payer: Blue Shield of California Commercial |
$626.13
|
| Rate for Payer: Blue Shield of California EPN |
$408.24
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$567.00
|
| Rate for Payer: Cigna of CA PPO |
$567.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$688.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$688.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$688.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Senior |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: InnovAge PACE Commercial |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$501.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$405.00
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Riverside University Health System MISP |
$324.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$486.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.99
|
| Rate for Payer: United Healthcare All Other HMO |
$295.89
|
| Rate for Payer: United Healthcare HMO Rider |
$289.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$688.50
|
| Rate for Payer: Vantage Medical Group Senior |
$688.50
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
IP
|
$4,993.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.60 |
| Max. Negotiated Rate |
$4,493.70 |
| Rate for Payer: Adventist Health Commercial |
$998.60
|
| Rate for Payer: Cash Price |
$2,746.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,994.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,997.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,997.20
|
| Rate for Payer: Galaxy Health WC |
$4,244.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,493.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,330.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,902.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,090.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.60
|
| Rate for Payer: Multiplan Commercial |
$3,744.75
|
| Rate for Payer: Networks By Design Commercial |
$3,245.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,244.05
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
OP
|
$4,993.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.69 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$998.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,244.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,746.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,744.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,417.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,932.39
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,746.15
|
| Rate for Payer: Cash Price |
$2,746.15
|
| Rate for Payer: Cash Price |
$2,746.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,994.40
|
| Rate for Payer: Cigna of CA HMO |
$3,195.52
|
| Rate for Payer: Cigna of CA PPO |
$3,694.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,244.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,244.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,244.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,997.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,997.20
|
| Rate for Payer: Galaxy Health WC |
$4,244.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,493.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$112.69
|
| Rate for Payer: InnovAge PACE Commercial |
$2,496.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,330.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,090.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,495.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,495.10
|
| Rate for Payer: Multiplan Commercial |
$3,744.75
|
| Rate for Payer: Networks By Design Commercial |
$3,245.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,244.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,997.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,995.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,244.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,244.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,244.05
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.14
|
| Rate for Payer: Blue Shield of California Commercial |
$329.94
|
| Rate for Payer: Blue Shield of California EPN |
$215.46
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: InnovAge PACE Commercial |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.00
|
| Rate for Payer: United Healthcare All Other HMO |
$270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$270.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$628.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$776.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$501.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$607.86
|
| Rate for Payer: Blue Shield of California Commercial |
$632.38
|
| Rate for Payer: Blue Shield of California EPN |
$412.96
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: InnovAge PACE Commercial |
$517.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$724.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.50
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Riverside University Health System MISP |
$414.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO |
$517.50
|
| Rate for Payer: United Healthcare HMO Rider |
$517.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC BALLOON UTERINE 24 FR DIA 54CML SILICONE
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901698135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,050.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,273.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC BALLOON UTERINE 24 FR DIA 54CML SILICONE
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901698135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,777.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,610.00
|
| Rate for Payer: Cigna of CA PPO |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$863.19
|
| Rate for Payer: United Healthcare All Other HMO |
$840.19
|
| Rate for Payer: United Healthcare HMO Rider |
$822.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$753.25
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,257.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,215.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,264.77
|
| Rate for Payer: Blue Shield of California EPN |
$825.93
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Riverside University Health System MISP |
$828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC BAL MED ENSEMBLE NU10 DEL CATH
|
Facility
|
IP
|
$16,250.00
|
|
| Hospital Charge Code |
906812445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,250.00 |
| Max. Negotiated Rate |
$14,625.00 |
| Rate for Payer: Adventist Health Commercial |
$3,250.00
|
| Rate for Payer: Cash Price |
$8,937.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,500.00
|
| Rate for Payer: Galaxy Health WC |
$13,812.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,191.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,058.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,250.00
|
| Rate for Payer: Multiplan Commercial |
$12,187.50
|
| Rate for Payer: Networks By Design Commercial |
$10,562.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,812.50
|
|
|
HC BAL MED ENSEMBLE NU10 DEL CATH
|
Facility
|
OP
|
$16,250.00
|
|
| Hospital Charge Code |
906812445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,250.00 |
| Max. Negotiated Rate |
$14,625.00 |
| Rate for Payer: Adventist Health Commercial |
$3,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,868.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,812.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,937.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,187.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,868.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,543.62
|
| Rate for Payer: Blue Shield of California Commercial |
$9,928.75
|
| Rate for Payer: Blue Shield of California EPN |
$6,483.75
|
| Rate for Payer: Cash Price |
$8,937.50
|
| Rate for Payer: Central Health Plan Commercial |
$13,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,400.00
|
| Rate for Payer: Cigna of CA PPO |
$12,025.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,812.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,812.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,812.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,500.00
|
| Rate for Payer: Galaxy Health WC |
$13,812.50
|
| Rate for Payer: Global Benefits Group Commercial |
$9,750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,625.00
|
| Rate for Payer: InnovAge PACE Commercial |
$8,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,838.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,191.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,058.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,375.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,375.00
|
| Rate for Payer: Multiplan Commercial |
$12,187.50
|
| Rate for Payer: Networks By Design Commercial |
$10,562.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,812.50
|
| Rate for Payer: Riverside University Health System MISP |
$6,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,812.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,812.50
|
| Rate for Payer: Vantage Medical Group Senior |
$13,812.50
|
|
|
HC BAL MED IN-PACT ADMIRAL 120MM
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$3,690.00 |
| Rate for Payer: Adventist Health Commercial |
$820.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,169.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,066.40
|
| Rate for Payer: Cash Price |
$2,255.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,280.00
|
| Rate for Payer: Cigna of CA HMO |
$2,870.00
|
| Rate for Payer: Cigna of CA PPO |
$2,870.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,640.00
|
| Rate for Payer: Galaxy Health WC |
$3,485.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,460.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,734.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,562.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,537.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$820.00
|
| Rate for Payer: Multiplan Commercial |
$3,075.00
|
| Rate for Payer: Networks By Design Commercial |
$2,050.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,485.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,538.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,497.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,465.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,342.75
|
|
|
HC BAL MED IN-PACT ADMIRAL 120MM
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$3,690.00 |
| Rate for Payer: Adventist Health Commercial |
$820.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,485.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,255.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,075.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,872.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,270.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,169.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,066.40
|
| Rate for Payer: Cash Price |
$2,255.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,280.00
|
| Rate for Payer: Cigna of CA HMO |
$2,870.00
|
| Rate for Payer: Cigna of CA PPO |
$2,870.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,485.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,485.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,485.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,640.00
|
| Rate for Payer: Galaxy Health WC |
$3,485.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,460.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,690.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,050.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,734.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,562.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,537.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$820.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.00
|
| Rate for Payer: Multiplan Commercial |
$3,075.00
|
| Rate for Payer: Networks By Design Commercial |
$2,050.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,485.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,640.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,460.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,460.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,538.73
|
| Rate for Payer: United Healthcare All Other HMO |
$1,497.73
|
| Rate for Payer: United Healthcare HMO Rider |
$1,465.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,342.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,485.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,485.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,485.00
|
|
|
HC BAL MED IN-PACT ADMIRAL 40-80MM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BAL MED IN-PACT ADMIRAL 40-80MM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
906812664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC BAL NUMED BIB
|
Facility
|
OP
|
$2,925.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,776.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,416.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,717.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,787.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,167.08
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: Cigna of CA HMO |
$1,872.00
|
| Rate for Payer: Cigna of CA PPO |
$2,164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,901.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,755.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,755.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,462.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,462.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,462.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC BAL NUMED BIB
|
Facility
|
IP
|
$2,925.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
906812439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,170.00
|
| Rate for Payer: Galaxy Health WC |
$2,486.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,755.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,950.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,114.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,810.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Networks By Design Commercial |
$1,901.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,486.25
|
|
|
HC BAL SEPTOSTOMY
|
Facility
|
IP
|
$8,448.00
|
|
|
Service Code
|
CPT 92992
|
| Hospital Charge Code |
906811114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.60 |
| Max. Negotiated Rate |
$7,603.20 |
| Rate for Payer: Adventist Health Commercial |
$1,689.60
|
| Rate for Payer: Cash Price |
$4,646.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,758.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,603.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,634.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,229.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.60
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$5,491.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
|
|
HC BAL SEPTOSTOMY
|
Facility
|
OP
|
$8,448.00
|
|
|
Service Code
|
CPT 92992
|
| Hospital Charge Code |
906811114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,689.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,646.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,336.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,090.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,961.51
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,646.40
|
| Rate for Payer: Cash Price |
$4,646.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,758.40
|
| Rate for Payer: Cigna of CA HMO |
$5,491.20
|
| Rate for Payer: Cigna of CA PPO |
$6,251.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,180.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,603.20
|
| Rate for Payer: InnovAge PACE Commercial |
$4,224.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,634.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,218.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,229.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,913.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,913.60
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$5,491.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,379.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,068.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,068.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,224.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,224.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,180.80
|
|
|
HC BAL SPECT BRIDGE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
906812685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,823.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC BAL SPECT BRIDGE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
906812685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,013.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,823.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,486.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,605.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,946.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,025.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.68
|
| Rate for Payer: Cash Price |
$1,823.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,817.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,817.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,657.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,211.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,263.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,051.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,320.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,320.50
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,326.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,657.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,657.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,657.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,657.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,817.75
|
|
