|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,979.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,979.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| 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
|
Facility
|
OP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$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: 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: InnovAge PACE Commercial |
$18,346.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,338.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,684.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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 |
$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
|
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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$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: 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: InnovAge PACE Commercial |
$18,346.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,338.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,684.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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 |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$20,802.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,882.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,305.37
|
| 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
|
IP
|
$36,692.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,979.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| 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
|
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 |
$15,101.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,316.71
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| 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: 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: InnovAge PACE Commercial |
$15,594.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,802.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,305.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,237.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,831.60
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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 |
$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 INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$36,692.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$607.06 |
| 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 |
$17,766.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,549.21
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| 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: 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 |
$607.06
|
| Rate for Payer: InnovAge PACE Commercial |
$18,346.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,473.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,712.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,338.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,684.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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 |
$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 INTRACAVITARY COMPLEX
|
Facility
|
OP
|
$29,825.00
|
|
|
Service Code
|
CPT 77763
|
| Hospital Charge Code |
909100403
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$194.54 |
| Max. Negotiated Rate |
$26,842.50 |
| Rate for Payer: Adventist Health Commercial |
$5,965.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$881.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18,112.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$958.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.54
|
| Rate for Payer: Blue Shield of California Commercial |
$18,103.78
|
| 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 |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| 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 |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,037.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: InnovAge PACE Commercial |
$1,322.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,893.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,146.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,965.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,181.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| 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 |
$881.55
|
| Rate for Payer: Prime Health Services Commercial |
$25,351.25
|
| Rate for Payer: Prime Health Services Medicare |
$934.44
|
| Rate for Payer: Riverside University Health System MISP |
$969.71
|
| 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 |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$19,893.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,363.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,461.67
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$47,863.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,340.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,418.82
|
| 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 |
$155.99 |
| Max. Negotiated Rate |
$64,583.10 |
| Rate for Payer: Adventist Health Commercial |
$14,351.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43,579.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$768.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.99
|
| Rate for Payer: Blue Shield of California Commercial |
$43,557.71
|
| 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 |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| 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 |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$735.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47,863.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,351.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| 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 |
$735.00
|
| Rate for Payer: Prime Health Services Commercial |
$60,995.15
|
| Rate for Payer: Prime Health Services Medicare |
$779.10
|
| Rate for Payer: Riverside University Health System MISP |
$808.50
|
| 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 |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
OP
|
$68,344.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$61,509.60 |
| Rate for Payer: Adventist Health Commercial |
$13,668.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$735.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41,505.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$535.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.64
|
| Rate for Payer: Blue Shield of California Commercial |
$41,484.81
|
| 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 |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| 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 |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$554.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45,585.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,668.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| 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 |
$735.00
|
| Rate for Payer: Prime Health Services Commercial |
$58,092.40
|
| Rate for Payer: Prime Health Services Medicare |
$779.10
|
| Rate for Payer: Riverside University Health System MISP |
$808.50
|
| 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 |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$45,585.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,039.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42,304.94
|
| 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
|
$1,472.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,177.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,324.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,177.60
|
| Rate for Payer: Cigna of CA HMO |
$942.08
|
| Rate for Payer: Cigna of CA PPO |
$1,089.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,324.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$311.85
|
| Rate for Payer: InnovAge PACE Commercial |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,030.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Riverside University Health System MISP |
$588.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$774.37
|
| 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$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: 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: InnovAge PACE Commercial |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$774.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
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 |
$20,121.30 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| 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 |
$10,825.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,130.27
|
| 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 |
$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: 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: InnovAge PACE Commercial |
$11,178.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,838.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,471.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,649.90
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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 |
$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 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: 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 Permanente of CA Commercial/Self Funded |
$14,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,518.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,838.98
|
| 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 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 |
$3,438.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,171.00
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| 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: 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: InnovAge PACE Commercial |
$3,551.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,737.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,396.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,420.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,971.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$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 |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6,036.70
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$4,737.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,705.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,396.14
|
| 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 INTRANASAL BX
|
Facility
|
IP
|
$4,171.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$834.20 |
| Max. Negotiated Rate |
$3,753.90 |
| Rate for Payer: Adventist Health Commercial |
$834.20
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,336.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,668.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,668.40
|
| Rate for Payer: Galaxy Health WC |
$3,545.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,753.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,782.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,589.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,581.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$834.20
|
| Rate for Payer: Multiplan Commercial |
$3,128.25
|
| Rate for Payer: Networks By Design Commercial |
$2,711.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,545.35
|
|
|
HC INTRANASAL BX
|
Facility
|
OP
|
$4,171.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$834.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,882.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Cash Price |
$1,876.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,336.80
|
| Rate for Payer: Cigna of CA HMO |
$2,669.44
|
| Rate for Payer: Cigna of CA PPO |
$3,086.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$3,545.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,502.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,753.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,782.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$834.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$3,128.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,711.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$3,545.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,502.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
OP
|
$10,363.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$9,326.70 |
| Rate for Payer: Adventist Health Commercial |
$2,072.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,293.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,808.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,699.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,772.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,017.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,086.19
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,290.40
|
| Rate for Payer: Cigna of CA HMO |
$6,632.32
|
| Rate for Payer: Cigna of CA PPO |
$7,668.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,808.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,808.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,808.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,145.20
|
| Rate for Payer: Galaxy Health WC |
$8,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,326.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$966.04
|
| Rate for Payer: InnovAge PACE Commercial |
$5,181.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,414.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,254.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,254.10
|
| Rate for Payer: Multiplan Commercial |
$7,772.25
|
| Rate for Payer: Networks By Design Commercial |
$6,735.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,808.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,145.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,808.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,808.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8,808.55
|
|
