|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$3,485.70 |
| Rate for Payer: Adventist Health Commercial |
$774.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| 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 |
$470.13
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,098.40
|
| Rate for Payer: Cigna of CA HMO |
$2,478.72
|
| Rate for Payer: Cigna of CA PPO |
$2,866.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,485.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$2,904.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,323.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,936.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,936.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,936.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,936.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,587.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,098.40
|
| Rate for Payer: Cigna of CA HMO |
$2,478.72
|
| Rate for Payer: Cigna of CA PPO |
$2,866.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,485.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$2,904.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,323.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,323.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$3,873.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$774.60 |
| Max. Negotiated Rate |
$3,485.70 |
| Rate for Payer: Adventist Health Commercial |
$774.60
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,098.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,549.20
|
| Rate for Payer: Galaxy Health WC |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,485.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,397.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.60
|
| Rate for Payer: Multiplan Commercial |
$2,904.75
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$3,873.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$774.60 |
| Max. Negotiated Rate |
$3,485.70 |
| Rate for Payer: Adventist Health Commercial |
$774.60
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,098.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,549.20
|
| Rate for Payer: Galaxy Health WC |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,485.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,475.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,397.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.60
|
| Rate for Payer: Multiplan Commercial |
$2,904.75
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$3,873.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$774.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$295.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| 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 |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Cash Price |
$2,130.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,098.40
|
| Rate for Payer: Cigna of CA HMO |
$2,478.72
|
| Rate for Payer: Cigna of CA PPO |
$2,866.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$3,292.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,323.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,485.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,583.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$774.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$2,904.75
|
| Rate for Payer: Networks By Design Commercial |
$2,517.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Prime Health Services Commercial |
$3,292.05
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,323.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,323.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC ENDOTRACH STYLET FLEXSLIP 14FR
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.34
|
| Rate for Payer: Blue Shield of California Commercial |
$9.72
|
| Rate for Payer: Blue Shield of California EPN |
$6.35
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: InnovAge PACE Commercial |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Riverside University Health System MISP |
$6.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC ENDOTRACH STYLET FLEXSLIP 14FR
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT A4212
|
| Hospital Charge Code |
901698673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$11.93
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC ENDOTRACH TUBE INTRO 15FRX70CM
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.94
|
| Rate for Payer: Blue Shield of California Commercial |
$43.64
|
| Rate for Payer: Blue Shield of California EPN |
$28.50
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: InnovAge PACE Commercial |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.99
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Riverside University Health System MISP |
$28.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC ENDOTRACH TUBE INTRO 15FRX70CM
|
Facility
|
IP
|
$71.42
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.82
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$12.11
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.31
|
| Rate for Payer: InnovAge PACE Commercial |
$15.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Riverside University Health System MISP |
$12.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.05
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: InnovAge PACE Commercial |
$21.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Riverside University Health System MISP |
$17.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
IP
|
$3,420.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.00 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Cash Price |
$1,881.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,736.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.00
|
| Rate for Payer: Galaxy Health WC |
$2,907.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,078.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,281.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,303.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,116.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
| Rate for Payer: Networks By Design Commercial |
$2,223.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,907.00
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
OP
|
$3,420.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,881.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,565.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,655.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,008.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,881.00
|
| Rate for Payer: Cash Price |
$1,881.00
|
| Rate for Payer: Cash Price |
$1,881.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,736.00
|
| Rate for Payer: Cigna of CA HMO |
$2,188.80
|
| Rate for Payer: Cigna of CA PPO |
$2,530.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,907.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,907.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.00
|
| Rate for Payer: Galaxy Health WC |
$2,907.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,078.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,281.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,116.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,394.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,394.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
| Rate for Payer: Networks By Design Commercial |
$2,223.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,907.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,368.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,907.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,907.00
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8,852.80 |
| Max. Negotiated Rate |
$39,837.60 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,705.60
|
| Rate for Payer: Galaxy Health WC |
$37,624.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,837.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,524.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,864.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,399.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.80
|
| Rate for Payer: Multiplan Commercial |
$33,198.00
|
| Rate for Payer: Networks By Design Commercial |
$28,771.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,624.40
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$39,837.60 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| 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 |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,194.00
|
| Rate for Payer: Blue Shield of California Commercial |
$26,868.25
|
| Rate for Payer: Blue Shield of California EPN |
$17,572.81
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,411.20
|
| Rate for Payer: Cigna of CA HMO |
$28,328.96
|
| Rate for Payer: Cigna of CA PPO |
$32,755.36
|
| 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 |
$37,624.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,837.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.10
|
| 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 |
$29,524.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.80
|
| 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 |
$33,198.00
|
| Rate for Payer: Networks By Design Commercial |
$28,771.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$37,624.40
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,558.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26,558.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,132.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22,132.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22,132.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,132.00
|
| 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 ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,807.60 |
| Max. Negotiated Rate |
$17,134.20 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| Rate for Payer: Cash Price |
$10,470.90
|
| Rate for Payer: Central Health Plan Commercial |
$15,230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,615.20
|
| Rate for Payer: Galaxy Health WC |
$16,182.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,422.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,134.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,698.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,253.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,784.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,807.60
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
| Rate for Payer: Networks By Design Commercial |
$12,374.70
|
| Rate for Payer: Prime Health Services Commercial |
$16,182.30
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,421.42 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| 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 |
$6,372.03
|
| 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 |
$10,470.90
|
| Rate for Payer: Cash Price |
$10,470.90
|
| Rate for Payer: Cash Price |
$10,470.90
|
| Rate for Payer: Central Health Plan Commercial |
$15,230.40
|
| Rate for Payer: Cigna of CA HMO |
$12,184.32
|
| Rate for Payer: Cigna of CA PPO |
$14,088.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$16,182.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,422.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,134.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,421.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,698.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,779.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,807.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$12,374.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$16,182.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,422.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.40
|
| Rate for Payer: EPIC Health Plan Senior |
$560.40
|
| Rate for Payer: Galaxy Health WC |
$1,190.85
|
| Rate for Payer: Global Benefits Group Commercial |
$840.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,260.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$850.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.42
|
| Rate for Payer: Blue Shield of California Commercial |
$850.41
|
| Rate for Payer: Blue Shield of California EPN |
$556.20
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,190.85
|
| Rate for Payer: Global Benefits Group Commercial |
$840.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,260.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$626.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$840.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$947.13 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,698.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,448.64
|
| Rate for Payer: InnovAge PACE Commercial |
$1,446.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,024.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,156.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,879.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,879.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$947.13 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,698.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,235.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,448.64
|
| Rate for Payer: InnovAge PACE Commercial |
$1,446.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,024.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,156.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
