|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
915357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,169.07 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Adventist Health Commercial |
$5,219.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,001.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,547.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,476.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9,840.29
|
| Rate for Payer: Blue Shield of California EPN |
$6,415.92
|
| Rate for Payer: Cash Price |
$7,001.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,820.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,219.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,911.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,820.50
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
905357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,169.07 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Adventist Health Commercial |
$5,219.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,001.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,547.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,476.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9,840.29
|
| Rate for Payer: Blue Shield of California EPN |
$6,415.92
|
| Rate for Payer: Cash Price |
$7,001.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,820.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,820.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,219.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,911.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$6,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,820.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,820.50
|
|
|
HC ELECT WRIST ROTAT UTAH AREM
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT L7259
|
| Hospital Charge Code |
915357261
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$11,457.00 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,840.29
|
| Rate for Payer: Blue Shield of California EPN |
$6,415.92
|
| Rate for Payer: Cash Price |
$7,001.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,184.00
|
| Rate for Payer: Cigna of CA HMO |
$8,911.00
|
| Rate for Payer: Cigna of CA PPO |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,490.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,850.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,879.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,546.00
|
| Rate for Payer: Multiplan Commercial |
$9,547.50
|
| Rate for Payer: Networks By Design Commercial |
$8,274.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,777.57
|
| Rate for Payer: United Healthcare All Other HMO |
$4,650.27
|
| Rate for Payer: United Healthcare HMO Rider |
$4,549.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,169.07
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
IP
|
$8,923.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,784.60 |
| Max. Negotiated Rate |
$8,030.70 |
| Rate for Payer: Adventist Health Commercial |
$1,784.60
|
| Rate for Payer: Cash Price |
$4,907.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,138.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,569.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,569.20
|
| Rate for Payer: Galaxy Health WC |
$7,584.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,353.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,030.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,399.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,523.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.60
|
| Rate for Payer: Multiplan Commercial |
$6,692.25
|
| Rate for Payer: Networks By Design Commercial |
$5,799.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,584.55
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
OP
|
$8,923.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,030.70 |
| Rate for Payer: Adventist Health Commercial |
$1,784.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,907.65
|
| Rate for Payer: Cash Price |
$4,907.65
|
| Rate for Payer: Cash Price |
$4,907.65
|
| Rate for Payer: Cash Price |
$4,907.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,138.40
|
| Rate for Payer: Cigna of CA HMO |
$5,710.72
|
| Rate for Payer: Cigna of CA PPO |
$6,603.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$7,584.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,353.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,030.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,951.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$6,692.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$5,799.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,584.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,353.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,461.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,461.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,461.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,461.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC EMBOLIC ONYX
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,500.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,739.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,322.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,638.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,800.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,100.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,400.00
|
| Rate for Payer: InnovAge PACE Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,714.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,200.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2,144.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,100.00
|
|
|
HC EMBOLIC ONYX
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,638.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,800.00
|
| Rate for Payer: Cigna of CA HMO |
$4,200.00
|
| Rate for Payer: Cigna of CA PPO |
$4,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.00
|
| Rate for Payer: Galaxy Health WC |
$5,100.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,002.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,714.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,191.80
|
| Rate for Payer: United Healthcare HMO Rider |
$2,144.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,965.00
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Blue Shield of California Commercial |
$276.73
|
| Rate for Payer: Blue Shield of California EPN |
$180.43
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Central Health Plan Commercial |
$286.40
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: Networks By Design Commercial |
$179.00
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.36
|
| Rate for Payer: United Healthcare All Other HMO |
$130.78
|
| Rate for Payer: United Healthcare HMO Rider |
$127.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.22
|
| Rate for Payer: Blue Shield of California Commercial |
$276.73
|
| Rate for Payer: Blue Shield of California EPN |
$180.43
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Central Health Plan Commercial |
$286.40
|
| Rate for Payer: Cigna of CA HMO |
$250.60
|
| Rate for Payer: Cigna of CA PPO |
$250.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.20
|
| Rate for Payer: Galaxy Health WC |
$304.30
|
| Rate for Payer: Global Benefits Group Commercial |
$214.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$322.20
|
| Rate for Payer: InnovAge PACE Commercial |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$221.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: Networks By Design Commercial |
$179.00
|
| Rate for Payer: Prime Health Services Commercial |
$304.30
|
| Rate for Payer: Riverside University Health System MISP |
$143.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.36
|
| Rate for Payer: United Healthcare All Other HMO |
$130.78
|
| Rate for Payer: United Healthcare HMO Rider |
$127.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,182.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,682.50
|
| Rate for Payer: Blue Shield of California Commercial |
$15,275.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,975.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,000.00
|
| Rate for Payer: Cigna of CA PPO |
$18,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
IP
|
$34,387.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,877.40 |
| Max. Negotiated Rate |
$30,948.30 |
| Rate for Payer: Adventist Health Commercial |
$6,877.40
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Central Health Plan Commercial |
$27,509.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,754.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,754.80
|
| Rate for Payer: Galaxy Health WC |
$29,228.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,632.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,948.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,936.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,101.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,285.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,877.40
|
| Rate for Payer: Multiplan Commercial |
$25,790.25
|
| Rate for Payer: Networks By Design Commercial |
$22,351.55
|
| Rate for Payer: Prime Health Services Commercial |
$29,228.95
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$34,387.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$6,877.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Central Health Plan Commercial |
$27,509.60
|
| Rate for Payer: Cigna of CA HMO |
$22,007.68
|
| Rate for Payer: Cigna of CA PPO |
$25,446.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$29,228.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,632.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,948.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,936.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,877.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$25,790.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$22,351.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$29,228.95
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,632.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$159.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.79
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
IP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$3,957.75 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Cash Price |
$2,418.62
|
| Rate for Payer: Central Health Plan Commercial |
$3,518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,759.00
|
| Rate for Payer: Galaxy Health WC |
$3,737.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,957.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,722.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.50
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
| Rate for Payer: Networks By Design Commercial |
$2,858.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.88
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
OP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.50 |
| Max. Negotiated Rate |
$3,957.75 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,670.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,418.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,298.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,129.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,686.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,754.60
|
| Rate for Payer: Cash Price |
$2,418.62
|
| Rate for Payer: Central Health Plan Commercial |
$3,518.00
|
| Rate for Payer: Cigna of CA HMO |
$2,814.40
|
| Rate for Payer: Cigna of CA PPO |
$3,254.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,737.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,737.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,759.00
|
| Rate for Payer: Galaxy Health WC |
$3,737.88
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,957.75
|
| Rate for Payer: InnovAge PACE Commercial |
$2,198.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,722.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$879.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,078.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,078.25
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
| Rate for Payer: Networks By Design Commercial |
$2,858.38
|
| Rate for Payer: Prime Health Services Commercial |
$3,737.88
|
| Rate for Payer: Riverside University Health System MISP |
$1,759.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,638.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,638.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,198.75
|
| Rate for Payer: United Healthcare All Other HMO |
$2,198.75
|
| Rate for Payer: United Healthcare HMO Rider |
$2,198.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,198.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,737.88
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
IP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$1,010.16 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Blue Shield of California Commercial |
$867.62
|
| Rate for Payer: Blue Shield of California EPN |
$565.69
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Central Health Plan Commercial |
$897.92
|
| Rate for Payer: Cigna of CA HMO |
$785.68
|
| Rate for Payer: Cigna of CA PPO |
$785.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.96
|
| Rate for Payer: EPIC Health Plan Senior |
$448.96
|
| Rate for Payer: Galaxy Health WC |
$954.04
|
| Rate for Payer: Global Benefits Group Commercial |
$673.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: Networks By Design Commercial |
$561.20
|
| Rate for Payer: Prime Health Services Commercial |
$954.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.24
|
| Rate for Payer: United Healthcare All Other HMO |
$410.01
|
| Rate for Payer: United Healthcare HMO Rider |
$401.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.59
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
OP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$1,010.16 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$512.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.47
|
| Rate for Payer: Blue Shield of California Commercial |
$867.62
|
| Rate for Payer: Blue Shield of California EPN |
$565.69
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Central Health Plan Commercial |
$897.92
|
| Rate for Payer: Cigna of CA HMO |
$785.68
|
| Rate for Payer: Cigna of CA PPO |
$785.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$954.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$954.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$954.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.96
|
| Rate for Payer: EPIC Health Plan Senior |
$448.96
|
| Rate for Payer: Galaxy Health WC |
$954.04
|
| Rate for Payer: Global Benefits Group Commercial |
$673.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.16
|
| Rate for Payer: InnovAge PACE Commercial |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$785.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$785.68
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: Networks By Design Commercial |
$561.20
|
| Rate for Payer: Prime Health Services Commercial |
$954.04
|
| Rate for Payer: Riverside University Health System MISP |
$448.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.24
|
| Rate for Payer: United Healthcare All Other HMO |
$410.01
|
| Rate for Payer: United Healthcare HMO Rider |
$401.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$954.04
|
| Rate for Payer: Vantage Medical Group Senior |
$954.04
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
OP
|
$13,709.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,435.68 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$2,741.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,652.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,539.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,281.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$7,539.95
|
| Rate for Payer: Cash Price |
$7,539.95
|
| Rate for Payer: Cash Price |
$7,539.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,967.20
|
| Rate for Payer: Cigna of CA HMO |
$8,773.76
|
| Rate for Payer: Cigna of CA PPO |
$10,144.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,652.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,652.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,652.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,483.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,483.60
|
| Rate for Payer: Galaxy Health WC |
$11,652.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,225.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,338.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,435.68
|
| Rate for Payer: InnovAge PACE Commercial |
$6,854.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,585.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,485.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,741.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,596.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,596.30
|
| Rate for Payer: Multiplan Commercial |
$10,281.75
|
| Rate for Payer: Networks By Design Commercial |
$8,910.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,652.65
|
| Rate for Payer: Riverside University Health System MISP |
$5,483.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,225.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,652.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,652.65
|
| Rate for Payer: Vantage Medical Group Senior |
$11,652.65
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
IP
|
$13,709.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,741.80 |
| Max. Negotiated Rate |
$12,338.10 |
| Rate for Payer: Adventist Health Commercial |
$2,741.80
|
| Rate for Payer: Cash Price |
$7,539.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,967.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,483.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,483.60
|
| Rate for Payer: Galaxy Health WC |
$11,652.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,225.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,338.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,223.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,485.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,741.80
|
| Rate for Payer: Multiplan Commercial |
$10,281.75
|
| Rate for Payer: Networks By Design Commercial |
$8,910.85
|
| Rate for Payer: Prime Health Services Commercial |
$11,652.65
|
|
|
HC EM EMBED ONLY
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
|
|
HC EM EMBED ONLY
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
903800053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$158.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.63
|
| Rate for Payer: Blue Shield of California Commercial |
$199.10
|
| Rate for Payer: Blue Shield of California EPN |
$130.22
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Cash Price |
$180.40
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: InnovAge PACE Commercial |
$101.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.89
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Prime Health Services Medicare |
$71.96
|
| Rate for Payer: Riverside University Health System MISP |
$74.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC END ABL THY INC VEIN 1ST VEIN
|
Facility
|
OP
|
$22,694.00
|
|
|
Service Code
|
CPT 36482
|
| Hospital Charge Code |
909026482
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,386.20 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,538.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$12,481.70
|
| Rate for Payer: Cash Price |
$12,481.70
|
| Rate for Payer: Cash Price |
$12,481.70
|
| Rate for Payer: Central Health Plan Commercial |
$18,155.20
|
| Rate for Payer: Cigna of CA HMO |
$14,524.16
|
| Rate for Payer: Cigna of CA PPO |
$16,793.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$19,289.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,616.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,424.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,386.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,740.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,538.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$17,020.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$14,751.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$19,289.90
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,616.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC END ABL THY INC VEIN 1ST VEIN
|
Facility
|
IP
|
$22,694.00
|
|
|
Service Code
|
CPT 36482
|
| Hospital Charge Code |
909026482
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,538.80 |
| Max. Negotiated Rate |
$20,424.60 |
| Rate for Payer: Adventist Health Commercial |
$4,538.80
|
| Rate for Payer: Cash Price |
$12,481.70
|
| Rate for Payer: Central Health Plan Commercial |
$18,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,077.60
|
| Rate for Payer: Galaxy Health WC |
$19,289.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,616.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,424.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,646.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,047.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,538.80
|
| Rate for Payer: Multiplan Commercial |
$17,020.50
|
| Rate for Payer: Networks By Design Commercial |
$14,751.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,289.90
|
|
