|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,129.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,162.53
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Cigna of CA HMO |
$6,780.16
|
| Rate for Payer: Cigna of CA PPO |
$7,839.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$9,004.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,356.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
OP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| 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 |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Cigna of CA HMO |
$6,780.16
|
| Rate for Payer: Cigna of CA PPO |
$7,839.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$9,004.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,356.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,297.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,297.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,297.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,118.80 |
| Max. Negotiated Rate |
$9,534.60 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Cash Price |
$4,767.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,475.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,415.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,237.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,237.60
|
| Rate for Payer: Galaxy Health WC |
$9,004.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,356.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,534.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,727.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,250.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.80
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
| Rate for Payer: Networks By Design Commercial |
$6,886.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,004.90
|
|
|
HC INTL CUSTM CONG/ATYP INSERT
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915340558
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.60 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,498.14
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$1,214.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
|
|
HC INTL CUSTM CONG/ATYP INSERT
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915340558
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.77 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$765.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,086.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,498.14
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,587.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,587.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,307.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Riverside University Health System MISP |
$747.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,587.80
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$2,553.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.60 |
| Max. Negotiated Rate |
$2,297.70 |
| Rate for Payer: Adventist Health Commercial |
$510.60
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,042.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,787.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,021.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,021.20
|
| Rate for Payer: Galaxy Health WC |
$2,170.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,531.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,297.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,621.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,506.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.60
|
| Rate for Payer: Multiplan Commercial |
$1,914.75
|
| Rate for Payer: Networks By Design Commercial |
$1,659.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,170.05
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$2,553.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.69 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$510.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,404.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,914.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Cash Price |
$1,148.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,042.40
|
| Rate for Payer: Cigna of CA HMO |
$1,633.92
|
| Rate for Payer: Cigna of CA PPO |
$1,889.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,170.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,170.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,787.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,021.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,021.20
|
| Rate for Payer: Galaxy Health WC |
$2,170.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,531.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,297.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$372.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,621.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$411.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,506.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,787.10
|
| Rate for Payer: Multiplan Commercial |
$1,914.75
|
| Rate for Payer: Networks By Design Commercial |
$1,659.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,170.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,021.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,531.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,276.50
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,170.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,170.05
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$167.80 |
| Max. Negotiated Rate |
$755.10 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Central Health Plan Commercial |
$671.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$587.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.60
|
| Rate for Payer: EPIC Health Plan Senior |
$335.60
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$755.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$532.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$495.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.80
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$755.10 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$488.05
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Central Health Plan Commercial |
$671.20
|
| Rate for Payer: Cigna of CA HMO |
$536.96
|
| Rate for Payer: Cigna of CA PPO |
$620.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$587.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$755.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$532.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$503.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
OP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.09 |
| Max. Negotiated Rate |
$33,022.80 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,180.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,519.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$16,511.40
|
| Rate for Payer: Cash Price |
$16,511.40
|
| Rate for Payer: Cash Price |
$16,511.40
|
| Rate for Payer: Central Health Plan Commercial |
$29,353.60
|
| Rate for Payer: Cigna of CA HMO |
$23,482.88
|
| Rate for Payer: Cigna of CA PPO |
$27,152.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,188.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,188.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,684.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,676.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,676.80
|
| Rate for Payer: Galaxy Health WC |
$31,188.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,015.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,022.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,299.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$338.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,648.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,338.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,684.40
|
| Rate for Payer: Multiplan Commercial |
$27,519.00
|
| Rate for Payer: Networks By Design Commercial |
$23,849.80
|
| Rate for Payer: Prime Health Services Commercial |
$31,188.20
|
| Rate for Payer: Riverside University Health System MISP |
$14,676.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,015.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,346.00
|
| 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 |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31,188.20
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,338.40 |
| Max. Negotiated Rate |
$33,022.80 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Cash Price |
$16,511.40
|
| Rate for Payer: Central Health Plan Commercial |
$29,353.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,684.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,676.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,676.80
|
| Rate for Payer: Galaxy Health WC |
$31,188.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,015.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,022.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,299.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,648.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,338.40
|
| Rate for Payer: Multiplan Commercial |
$27,519.00
|
| Rate for Payer: Networks By Design Commercial |
$23,849.80
|
| Rate for Payer: Prime Health Services Commercial |
$31,188.20
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
IP
|
$31,188.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,237.60 |
| Max. Negotiated Rate |
$28,069.20 |
| Rate for Payer: Adventist Health Commercial |
$6,237.60
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Central Health Plan Commercial |
$24,950.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,831.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,475.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,475.20
|
| Rate for Payer: Galaxy Health WC |
$26,509.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18,712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,069.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,804.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,400.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,237.60
|
| Rate for Payer: Multiplan Commercial |
$23,391.00
|
| Rate for Payer: Networks By Design Commercial |
$20,272.20
|
| Rate for Payer: Prime Health Services Commercial |
$26,509.80
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$31,188.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$607.06 |
| Max. Negotiated Rate |
$28,069.20 |
| Rate for Payer: Adventist Health Commercial |
$6,237.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,509.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,153.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,391.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Cash Price |
$14,034.60
|
| Rate for Payer: Central Health Plan Commercial |
$24,950.40
|
| Rate for Payer: Cigna of CA HMO |
$19,960.32
|
| Rate for Payer: Cigna of CA PPO |
$23,079.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,509.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,509.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,509.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,831.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,475.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,475.20
|
| Rate for Payer: Galaxy Health WC |
$26,509.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18,712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,069.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,804.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$670.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,400.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,237.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,831.60
|
| Rate for Payer: Multiplan Commercial |
$23,391.00
|
| Rate for Payer: Networks By Design Commercial |
$20,272.20
|
| Rate for Payer: Prime Health Services Commercial |
$26,509.80
|
| Rate for Payer: Riverside University Health System MISP |
$12,475.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,712.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,594.00
|
| 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 |
$26,509.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,509.80
|
| Rate for Payer: Vantage Medical Group Senior |
$26,509.80
|
|
|
HC INTRACAVITARY COMPLEX
|
Facility
|
OP
|
$29,825.00
|
|
|
Service Code
|
CPT 77763
|
| Hospital Charge Code |
909100403
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$895.78 |
| Max. Negotiated Rate |
$26,842.50 |
| Rate for Payer: Adventist Health Commercial |
$5,965.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$895.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,688.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$895.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$958.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,332.59
|
| Rate for Payer: Blue Shield of California Commercial |
$18,789.75
|
| Rate for Payer: Blue Shield of California EPN |
$11,840.52
|
| Rate for Payer: Cash Price |
$13,421.25
|
| Rate for Payer: Cash Price |
$13,421.25
|
| Rate for Payer: Cash Price |
$13,421.25
|
| Rate for Payer: Central Health Plan Commercial |
$23,860.00
|
| Rate for Payer: Cigna of CA HMO |
$19,088.00
|
| Rate for Payer: Cigna of CA PPO |
$22,070.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$985.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,877.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,478.04
|
| Rate for Payer: EPIC Health Plan Senior |
$985.36
|
| Rate for Payer: Galaxy Health WC |
$25,351.25
|
| Rate for Payer: Global Benefits Group Commercial |
$17,895.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,842.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,469.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,037.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$895.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,938.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,146.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,965.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,200.35
|
| Rate for Payer: Multiplan Commercial |
$22,368.75
|
| Rate for Payer: Networks By Design Commercial |
$19,386.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$895.78
|
| Rate for Payer: Prime Health Services Commercial |
$25,351.25
|
| Rate for Payer: Prime Health Services Medicare |
$949.53
|
| Rate for Payer: Riverside University Health System MISP |
$985.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,895.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$895.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,343.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$985.36
|
| Rate for Payer: Vantage Medical Group Senior |
$895.78
|
|
|
HC INTRACAVITARY COMPLEX
|
Facility
|
IP
|
$29,825.00
|
|
|
Service Code
|
CPT 77763
|
| Hospital Charge Code |
909100403
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,965.00 |
| Max. Negotiated Rate |
$26,842.50 |
| Rate for Payer: Adventist Health Commercial |
$5,965.00
|
| Rate for Payer: Cash Price |
$13,421.25
|
| Rate for Payer: Central Health Plan Commercial |
$23,860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,877.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$11,930.00
|
| Rate for Payer: Galaxy Health WC |
$25,351.25
|
| Rate for Payer: Global Benefits Group Commercial |
$17,895.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,842.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,938.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,596.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,965.00
|
| Rate for Payer: Multiplan Commercial |
$22,368.75
|
| Rate for Payer: Networks By Design Commercial |
$19,386.25
|
| Rate for Payer: Prime Health Services Commercial |
$25,351.25
|
|
|
HC INTRACAVITARY INTER
|
Facility
|
IP
|
$71,759.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$14,351.80 |
| Max. Negotiated Rate |
$64,583.10 |
| Rate for Payer: Adventist Health Commercial |
$14,351.80
|
| Rate for Payer: Cash Price |
$32,291.55
|
| Rate for Payer: Central Health Plan Commercial |
$57,407.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50,231.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,703.60
|
| Rate for Payer: EPIC Health Plan Senior |
$28,703.60
|
| Rate for Payer: Galaxy Health WC |
$60,995.15
|
| Rate for Payer: Global Benefits Group Commercial |
$43,055.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$64,583.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45,566.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,337.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,351.80
|
| Rate for Payer: Multiplan Commercial |
$53,819.25
|
| Rate for Payer: Networks By Design Commercial |
$46,643.35
|
| Rate for Payer: Prime Health Services Commercial |
$60,995.15
|
|
|
HC INTRACAVITARY INTER
|
Facility
|
OP
|
$71,759.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$710.66 |
| Max. Negotiated Rate |
$64,583.10 |
| Rate for Payer: Adventist Health Commercial |
$14,351.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$710.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,305.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$768.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,068.54
|
| Rate for Payer: Blue Shield of California Commercial |
$45,208.17
|
| Rate for Payer: Blue Shield of California EPN |
$28,488.32
|
| Rate for Payer: Cash Price |
$32,291.55
|
| Rate for Payer: Cash Price |
$32,291.55
|
| Rate for Payer: Central Health Plan Commercial |
$57,407.20
|
| Rate for Payer: Cigna of CA HMO |
$45,925.76
|
| Rate for Payer: Cigna of CA PPO |
$53,101.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50,231.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,172.59
|
| Rate for Payer: EPIC Health Plan Senior |
$781.73
|
| Rate for Payer: Galaxy Health WC |
$60,995.15
|
| Rate for Payer: Global Benefits Group Commercial |
$43,055.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$64,583.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,165.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$735.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45,566.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$812.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,351.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$952.28
|
| Rate for Payer: Multiplan Commercial |
$53,819.25
|
| Rate for Payer: Networks By Design Commercial |
$46,643.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$710.66
|
| Rate for Payer: Prime Health Services Commercial |
$60,995.15
|
| Rate for Payer: Prime Health Services Medicare |
$753.30
|
| Rate for Payer: Riverside University Health System MISP |
$781.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43,055.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43,055.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35,879.50
|
| Rate for Payer: United Healthcare All Other HMO |
$35,879.50
|
| Rate for Payer: United Healthcare HMO Rider |
$35,879.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35,879.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$710.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
OP
|
$68,344.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$535.32 |
| Max. Negotiated Rate |
$61,509.60 |
| Rate for Payer: Adventist Health Commercial |
$13,668.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$710.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,116.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$744.22
|
| Rate for Payer: Blue Shield of California Commercial |
$43,056.72
|
| Rate for Payer: Blue Shield of California EPN |
$27,132.57
|
| Rate for Payer: Cash Price |
$30,754.80
|
| Rate for Payer: Cash Price |
$30,754.80
|
| Rate for Payer: Central Health Plan Commercial |
$54,675.20
|
| Rate for Payer: Cigna of CA HMO |
$43,740.16
|
| Rate for Payer: Cigna of CA PPO |
$50,574.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$781.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47,840.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,172.59
|
| Rate for Payer: EPIC Health Plan Senior |
$781.73
|
| Rate for Payer: Galaxy Health WC |
$58,092.40
|
| Rate for Payer: Global Benefits Group Commercial |
$41,006.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$61,509.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,165.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$554.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$710.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43,398.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$612.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$994.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,668.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$952.28
|
| Rate for Payer: Multiplan Commercial |
$51,258.00
|
| Rate for Payer: Networks By Design Commercial |
$44,423.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$710.66
|
| Rate for Payer: Prime Health Services Commercial |
$58,092.40
|
| Rate for Payer: Prime Health Services Medicare |
$753.30
|
| Rate for Payer: Riverside University Health System MISP |
$781.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41,006.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41,006.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34,172.00
|
| Rate for Payer: United Healthcare All Other HMO |
$34,172.00
|
| Rate for Payer: United Healthcare HMO Rider |
$34,172.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,172.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$710.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$781.73
|
| Rate for Payer: Vantage Medical Group Senior |
$710.66
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
IP
|
$68,344.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$13,668.80 |
| Max. Negotiated Rate |
$61,509.60 |
| Rate for Payer: Adventist Health Commercial |
$13,668.80
|
| Rate for Payer: Cash Price |
$30,754.80
|
| Rate for Payer: Central Health Plan Commercial |
$54,675.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47,840.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27,337.60
|
| Rate for Payer: Galaxy Health WC |
$58,092.40
|
| Rate for Payer: Global Benefits Group Commercial |
$41,006.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$61,509.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43,398.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,322.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,668.80
|
| Rate for Payer: Multiplan Commercial |
$51,258.00
|
| Rate for Payer: Networks By Design Commercial |
$44,423.60
|
| Rate for Payer: Prime Health Services Commercial |
$58,092.40
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$1,125.90 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$794.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$738.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.20
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$813.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$938.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$800.64
|
| Rate for Payer: Cigna of CA PPO |
$925.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,063.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$311.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$794.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$738.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$813.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: Riverside University Health System MISP |
$500.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$625.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
IP
|
$22,357.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,471.40 |
| Max. Negotiated Rate |
$20,121.30 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Central Health Plan Commercial |
$17,885.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,649.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,942.80
|
| Rate for Payer: Galaxy Health WC |
$19,003.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,414.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,121.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,190.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,471.40
|
| Rate for Payer: Multiplan Commercial |
$16,767.75
|
| Rate for Payer: Networks By Design Commercial |
$14,532.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,003.45
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
OP
|
$22,357.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,139.19 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,003.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,296.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,767.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Central Health Plan Commercial |
$17,885.60
|
| Rate for Payer: Cigna of CA HMO |
$14,308.48
|
| Rate for Payer: Cigna of CA PPO |
$16,544.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,003.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,003.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,003.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,649.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,942.80
|
| Rate for Payer: Galaxy Health WC |
$19,003.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,414.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,121.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,139.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,258.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,190.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,471.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,649.90
|
| Rate for Payer: Multiplan Commercial |
$16,767.75
|
| Rate for Payer: Networks By Design Commercial |
$14,532.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,003.45
|
| Rate for Payer: Riverside University Health System MISP |
$8,942.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,414.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,178.50
|
| 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 |
$19,003.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,003.45
|
| Rate for Payer: Vantage Medical Group Senior |
$19,003.45
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
IP
|
$7,102.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,420.40 |
| Max. Negotiated Rate |
$6,391.80 |
| Rate for Payer: Adventist Health Commercial |
$1,420.40
|
| Rate for Payer: Cash Price |
$3,195.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,681.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,971.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,840.80
|
| Rate for Payer: Galaxy Health WC |
$6,036.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,261.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,391.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,509.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,190.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,420.40
|
| Rate for Payer: Multiplan Commercial |
$5,326.50
|
| Rate for Payer: Networks By Design Commercial |
$4,616.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,036.70
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
OP
|
$7,102.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,420.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,036.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,906.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,326.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,195.90
|
| Rate for Payer: Cash Price |
$3,195.90
|
| Rate for Payer: Cash Price |
$3,195.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,681.60
|
| Rate for Payer: Cigna of CA HMO |
$4,545.28
|
| Rate for Payer: Cigna of CA PPO |
$5,255.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,036.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,036.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,036.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,971.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,840.80
|
| Rate for Payer: Galaxy Health WC |
$6,036.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,261.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,391.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$763.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,509.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$843.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,190.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,420.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,971.40
|
| Rate for Payer: Multiplan Commercial |
$5,326.50
|
| Rate for Payer: Networks By Design Commercial |
$4,616.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,036.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,840.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,261.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,551.00
|
| 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 |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6,036.70
|
|
