|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
OP
|
$1,594.08
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.82 |
| Max. Negotiated Rate |
$1,434.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$968.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,354.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$876.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$876.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$771.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$941.78
|
| Rate for Payer: Blue Distinction Transplant |
$956.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,002.68
|
| Rate for Payer: Blue Shield of California EPN |
$779.51
|
| Rate for Payer: Cash Price |
$717.34
|
| Rate for Payer: Central Health Plan Commercial |
$1,275.26
|
| Rate for Payer: Cigna of CA HMO |
$1,020.21
|
| Rate for Payer: Cigna of CA PPO |
$1,179.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,354.97
|
| Rate for Payer: Dignity Health Media |
$1,354.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,354.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$637.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$637.63
|
| Rate for Payer: Galaxy Health WC |
$1,354.97
|
| Rate for Payer: Global Benefits Group Commercial |
$956.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,434.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,195.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$557.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,063.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$607.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.82
|
| Rate for Payer: Multiplan Commercial |
$1,195.56
|
| Rate for Payer: Networks By Design Commercial |
$1,036.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,354.97
|
| Rate for Payer: Riverside University Health System MISP |
$637.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$956.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$956.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$797.04
|
| Rate for Payer: United Healthcare All Other HMO |
$797.04
|
| Rate for Payer: United Healthcare HMO Rider |
$797.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$797.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,354.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,354.97
|
|
|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
IP
|
$1,594.08
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.82 |
| Max. Negotiated Rate |
$1,434.67 |
| Rate for Payer: Cash Price |
$717.34
|
| Rate for Payer: Central Health Plan Commercial |
$1,275.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$637.63
|
| Rate for Payer: Galaxy Health WC |
$1,354.97
|
| Rate for Payer: Global Benefits Group Commercial |
$956.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,434.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,063.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$607.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.82
|
| Rate for Payer: Multiplan Commercial |
$1,195.56
|
| Rate for Payer: Networks By Design Commercial |
$1,036.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,354.97
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
IP
|
$1,882.09
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.42 |
| Max. Negotiated Rate |
$1,693.88 |
| Rate for Payer: Cash Price |
$846.94
|
| Rate for Payer: Central Health Plan Commercial |
$1,505.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$752.84
|
| Rate for Payer: Galaxy Health WC |
$1,599.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,129.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,693.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,255.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.42
|
| Rate for Payer: Multiplan Commercial |
$1,411.57
|
| Rate for Payer: Networks By Design Commercial |
$1,223.36
|
| Rate for Payer: Prime Health Services Commercial |
$1,599.78
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
OP
|
$1,882.09
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.42 |
| Max. Negotiated Rate |
$1,693.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,142.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,599.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,035.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$911.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,111.94
|
| Rate for Payer: Blue Distinction Transplant |
$1,129.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,183.83
|
| Rate for Payer: Blue Shield of California EPN |
$920.34
|
| Rate for Payer: Cash Price |
$846.94
|
| Rate for Payer: Central Health Plan Commercial |
$1,505.67
|
| Rate for Payer: Cigna of CA HMO |
$1,204.54
|
| Rate for Payer: Cigna of CA PPO |
$1,392.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,599.78
|
| Rate for Payer: Dignity Health Media |
$1,599.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,599.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$752.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$752.84
|
| Rate for Payer: Galaxy Health WC |
$1,599.78
|
| Rate for Payer: Global Benefits Group Commercial |
$1,129.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,693.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,411.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$658.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,255.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.42
|
| Rate for Payer: Multiplan Commercial |
$1,411.57
|
| Rate for Payer: Networks By Design Commercial |
$1,223.36
|
| Rate for Payer: Prime Health Services Commercial |
$1,599.78
|
| Rate for Payer: Riverside University Health System MISP |
$752.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,129.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,129.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$941.04
|
| Rate for Payer: United Healthcare All Other HMO |
$941.04
|
| Rate for Payer: United Healthcare HMO Rider |
$941.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,599.78
|
| Rate for Payer: Vantage Medical Group Senior |
$1,599.78
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.55
|
| Rate for Payer: Blue Shield of California EPN |
$31.10
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,117.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$683.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$601.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$733.77
|
| Rate for Payer: Blue Distinction Transplant |
$745.20
|
| Rate for Payer: Blue Shield of California Commercial |
$781.22
|
| Rate for Payer: Blue Shield of California EPN |
$607.34
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$919.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Dignity Health Media |
$1,055.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,055.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$931.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
| Rate for Payer: Riverside University Health System MISP |
$496.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO |
$621.00
|
| Rate for Payer: United Healthcare HMO Rider |
$621.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,055.70
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,117.80 |
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$828.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
|
|
HC BALLOON, AMPHIRION
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,472.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.00
|
| Rate for Payer: Galaxy Health WC |
$1,564.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,656.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$1,196.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.00
|
|
|
HC BALLOON, AMPHIRION
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,012.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$890.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.07
|
| Rate for Payer: Blue Distinction Transplant |
$1,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,157.36
|
| Rate for Payer: Blue Shield of California EPN |
$899.76
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,472.00
|
| Rate for Payer: Cigna of CA HMO |
$1,177.60
|
| Rate for Payer: Cigna of CA PPO |
$1,361.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Dignity Health Media |
$1,564.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,564.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$736.00
|
| Rate for Payer: Galaxy Health WC |
$1,564.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,104.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,656.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,380.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$644.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,227.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$1,196.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,564.00
|
| Rate for Payer: Riverside University Health System MISP |
$736.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,104.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,104.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$920.00
|
| Rate for Payer: United Healthcare All Other HMO |
$920.00
|
| Rate for Payer: United Healthcare HMO Rider |
$920.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$920.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,564.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,564.00
|
|
|
HC BALLOON, ASCENT
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| 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 |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| 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: 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
|
| 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BALLOON, ASCENT
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 DILATATION CATHETER
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$891.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$784.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$957.10
|
| Rate for Payer: Blue Distinction Transplant |
$972.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,018.98
|
| Rate for Payer: Blue Shield of California EPN |
$792.18
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.80
|
| Rate for Payer: Cigna of CA PPO |
$1,198.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Media |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Riverside University Health System MISP |
$648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC BALLOON DILATATION CATHETER
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
|
|
HC BALLOON, EV3 EVERCROSS
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.01
|
| Rate for Payer: Blue Distinction Transplant |
$469.20
|
| Rate for Payer: Blue Shield of California Commercial |
$491.88
|
| Rate for Payer: Blue Shield of California EPN |
$382.40
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$500.48
|
| Rate for Payer: Cigna of CA PPO |
$578.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Media |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$586.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$273.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Riverside University Health System MISP |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other HMO |
$391.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC BALLOON, EV3 EVERCROSS
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
|
HC BALLOON GATEWAY
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| 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 |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,172.30
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,925.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,121.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| 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: 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: 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BALLOON GATEWAY
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,082.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,287.00
|
|
|
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: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 HYPERFORM
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$2,309.05
|
| 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 |
$2,145.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,304.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,907.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Media |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,925.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,365.00
|
| 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: 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
|
| 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 |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
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: 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 |
$445.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.17
|
| Rate for Payer: Blue Distinction Transplant |
$486.00
|
| Rate for Payer: Blue Shield of California Commercial |
$607.50
|
| Rate for Payer: Blue Shield of California EPN |
$440.64
|
| Rate for Payer: Cash Price |
$364.50
|
| 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 Media |
$688.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$688.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$607.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$283.50
|
| 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: 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: 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 |
$405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$405.00
|
| Rate for Payer: United Healthcare HMO Rider |
$405.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$405.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$688.50
|
| Rate for Payer: Vantage Medical Group Senior |
$688.50
|
|
|
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: Blue Shield of California EPN |
$432.54
|
| Rate for Payer: Cash Price |
$364.50
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.86
|
| Rate for Payer: United Healthcare All Other HMO |
$298.73
|
| Rate for Payer: United Healthcare HMO Rider |
$292.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.30
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
IP
|
$4,239.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$847.80 |
| Max. Negotiated Rate |
$3,815.10 |
| Rate for Payer: Cash Price |
$1,907.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,391.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.60
|
| Rate for Payer: Galaxy Health WC |
$3,603.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,543.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,815.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,827.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.80
|
| Rate for Payer: Multiplan Commercial |
$3,179.25
|
| Rate for Payer: Networks By Design Commercial |
$2,755.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,603.15
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
OP
|
$4,239.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,603.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,331.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,331.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,543.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,907.55
|
| Rate for Payer: Cash Price |
$1,907.55
|
| Rate for Payer: Cash Price |
$1,907.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,391.20
|
| Rate for Payer: Cigna of CA PPO |
$3,136.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,603.15
|
| Rate for Payer: Dignity Health Media |
$3,603.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,603.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,695.60
|
| Rate for Payer: Galaxy Health WC |
$3,603.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,543.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,815.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,179.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,483.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,827.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.80
|
| Rate for Payer: Multiplan Commercial |
$3,179.25
|
| Rate for Payer: Networks By Design Commercial |
$2,755.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,603.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,695.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,543.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,603.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,603.15
|
|
|
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 |
$2,309.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,309.05
|
| 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 |
$297.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.03
|
| Rate for Payer: Blue Distinction Transplant |
$324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$339.66
|
| Rate for Payer: Blue Shield of California EPN |
$264.06
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| 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 Media |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$405.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.00
|
| 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: 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
|
| 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 Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
