|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
OP
|
$1,723.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$344.60 |
| Max. Negotiated Rate |
$1,464.55 |
| Rate for Payer: Adventist Health Commercial |
$344.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,130.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,464.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$947.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,058.09
|
| Rate for Payer: Cash Price |
$775.35
|
| Rate for Payer: Cigna of CA HMO |
$1,102.72
|
| Rate for Payer: Cigna of CA PPO |
$1,275.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,464.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,464.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,464.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.20
|
| Rate for Payer: EPIC Health Plan Senior |
$689.20
|
| Rate for Payer: Galaxy Health WC |
$1,464.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,066.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,206.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,206.10
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: Networks By Design Commercial |
$1,119.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,464.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,033.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,033.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$861.50
|
| Rate for Payer: United Healthcare All Other HMO |
$861.50
|
| Rate for Payer: United Healthcare HMO Rider |
$861.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$861.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,464.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,464.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,464.55
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
IP
|
$1,723.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$344.60 |
| Max. Negotiated Rate |
$1,464.55 |
| Rate for Payer: Adventist Health Commercial |
$344.60
|
| Rate for Payer: Cash Price |
$775.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.20
|
| Rate for Payer: EPIC Health Plan Senior |
$689.20
|
| Rate for Payer: Galaxy Health WC |
$1,464.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,066.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.52
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: Networks By Design Commercial |
$1,119.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,464.55
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
IP
|
$284.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
OP
|
$284.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.40
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.80
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.00
|
| Rate for Payer: United Healthcare All Other HMO |
$142.00
|
| Rate for Payer: United Healthcare HMO Rider |
$142.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
OP
|
$2,944.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$2,502.40 |
| Rate for Payer: Adventist Health Commercial |
$588.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,930.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,502.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,619.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,208.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,807.91
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cigna of CA HMO |
$1,884.16
|
| Rate for Payer: Cigna of CA PPO |
$2,178.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,502.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,502.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,502.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,177.60
|
| Rate for Payer: Galaxy Health WC |
$2,502.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,766.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,963.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,822.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,060.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,060.80
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: Networks By Design Commercial |
$1,913.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,502.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,766.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,766.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,472.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,472.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,472.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,502.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,502.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,502.40
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
IP
|
$2,944.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$2,502.40 |
| Rate for Payer: Adventist Health Commercial |
$588.80
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,177.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,177.60
|
| Rate for Payer: Galaxy Health WC |
$2,502.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,766.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,963.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,822.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.56
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: Networks By Design Commercial |
$1,913.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,502.40
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
OP
|
$499.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.44
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.30
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
IP
|
$499.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
IP
|
$3,925.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$785.00 |
| Max. Negotiated Rate |
$3,336.25 |
| Rate for Payer: Adventist Health Commercial |
$785.00
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,570.00
|
| Rate for Payer: Galaxy Health WC |
$3,336.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,355.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,429.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.00
|
| Rate for Payer: Multiplan Commercial |
$3,140.00
|
| Rate for Payer: Networks By Design Commercial |
$2,551.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,336.25
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
OP
|
$3,925.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$785.00 |
| Max. Negotiated Rate |
$3,336.25 |
| Rate for Payer: Adventist Health Commercial |
$785.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,574.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,336.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,158.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,943.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,410.34
|
| Rate for Payer: Cash Price |
$1,766.25
|
| Rate for Payer: Cigna of CA HMO |
$2,512.00
|
| Rate for Payer: Cigna of CA PPO |
$2,904.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,336.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,336.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,336.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,570.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,570.00
|
| Rate for Payer: Galaxy Health WC |
$3,336.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,355.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,617.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,495.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,429.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$942.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,747.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,747.50
|
| Rate for Payer: Multiplan Commercial |
$3,140.00
|
| Rate for Payer: Networks By Design Commercial |
$2,551.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,336.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,355.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,355.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,962.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,962.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,962.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,962.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,336.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,336.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,336.25
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
IP
|
$690.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
OP
|
$690.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$586.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$379.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$517.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$423.73
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$586.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$586.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$586.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$483.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$483.00
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$345.00
|
| Rate for Payer: United Healthcare HMO Rider |
$345.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$345.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$586.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$586.50
|
| Rate for Payer: Vantage Medical Group Senior |
$586.50
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
OP
|
$4,894.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$978.80 |
| Max. Negotiated Rate |
$4,159.90 |
| Rate for Payer: Adventist Health Commercial |
$978.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,209.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,159.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,691.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,670.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,005.41
|
| Rate for Payer: Cash Price |
$2,202.30
|
| Rate for Payer: Cigna of CA HMO |
$3,132.16
|
| Rate for Payer: Cigna of CA PPO |
$3,621.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,159.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,159.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,159.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,957.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,957.60
|
| Rate for Payer: Galaxy Health WC |
$4,159.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,936.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,264.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,864.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,029.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,425.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,425.80
|
| Rate for Payer: Multiplan Commercial |
$3,915.20
|
| Rate for Payer: Networks By Design Commercial |
$3,181.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,159.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,936.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,936.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,447.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,447.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,447.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,159.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,159.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,159.90
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
IP
|
$4,894.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$978.80 |
| Max. Negotiated Rate |
$4,159.90 |
| Rate for Payer: Adventist Health Commercial |
$978.80
|
| Rate for Payer: Cash Price |
$2,202.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,957.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,957.60
|
| Rate for Payer: Galaxy Health WC |
$4,159.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,936.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,264.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,864.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,029.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.56
|
| Rate for Payer: Multiplan Commercial |
$3,915.20
|
| Rate for Payer: Networks By Design Commercial |
$3,181.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,159.90
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
IP
|
$881.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$176.20 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: EPIC Health Plan Senior |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
OP
|
$881.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$176.20 |
| Max. Negotiated Rate |
$748.85 |
| Rate for Payer: Adventist Health Commercial |
$176.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$577.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$541.02
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$748.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: EPIC Health Plan Senior |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$616.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$616.70
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.50
|
| Rate for Payer: United Healthcare All Other HMO |
$440.50
|
| Rate for Payer: United Healthcare HMO Rider |
$440.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$748.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.85
|
| Rate for Payer: Vantage Medical Group Senior |
$748.85
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
IP
|
$5,876.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,175.20 |
| Max. Negotiated Rate |
$4,994.60 |
| Rate for Payer: Adventist Health Commercial |
$1,175.20
|
| Rate for Payer: Cash Price |
$2,644.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.40
|
| Rate for Payer: Galaxy Health WC |
$4,994.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,919.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,637.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.24
|
| Rate for Payer: Multiplan Commercial |
$4,700.80
|
| Rate for Payer: Networks By Design Commercial |
$3,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,994.60
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
OP
|
$5,876.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,175.20 |
| Max. Negotiated Rate |
$4,994.60 |
| Rate for Payer: Adventist Health Commercial |
$1,175.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,854.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,994.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,231.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,407.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,608.45
|
| Rate for Payer: Cash Price |
$2,644.20
|
| Rate for Payer: Cigna of CA HMO |
$3,760.64
|
| Rate for Payer: Cigna of CA PPO |
$4,348.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,994.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,994.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,994.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.40
|
| Rate for Payer: Galaxy Health WC |
$4,994.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,919.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,637.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,113.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,113.20
|
| Rate for Payer: Multiplan Commercial |
$4,700.80
|
| Rate for Payer: Networks By Design Commercial |
$3,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,994.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,525.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,525.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,938.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,938.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,938.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,938.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,994.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,994.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,994.60
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
OP
|
$1,087.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$815.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.53
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cigna of CA HMO |
$695.68
|
| Rate for Payer: Cigna of CA PPO |
$804.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.90
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$652.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$652.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$543.50
|
| Rate for Payer: United Healthcare All Other HMO |
$543.50
|
| Rate for Payer: United Healthcare HMO Rider |
$543.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$543.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.95
|
| Rate for Payer: Vantage Medical Group Senior |
$923.95
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
IP
|
$1,087.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$3,794.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$3,541.16 |
| Rate for Payer: Adventist Health Commercial |
$758.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,488.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,224.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,086.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,845.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,321.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,532.78
|
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: Cigna of CA HMO |
$2,428.16
|
| Rate for Payer: Cigna of CA PPO |
$2,807.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,224.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,224.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,224.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,517.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,517.60
|
| Rate for Payer: Galaxy Health WC |
$3,224.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,276.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,348.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,655.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,655.80
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: Networks By Design Commercial |
$2,466.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,224.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,276.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,276.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,897.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,897.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,897.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,897.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,224.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,224.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3,224.90
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$5,134.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$4,363.90 |
| Rate for Payer: Adventist Health Commercial |
$1,026.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,367.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,363.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,823.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,850.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,541.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3,142.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,074.14
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna of CA HMO |
$3,285.76
|
| Rate for Payer: Cigna of CA PPO |
$3,799.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,363.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,363.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,363.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.60
|
| Rate for Payer: Galaxy Health WC |
$4,363.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,080.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,424.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,593.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,593.80
|
| Rate for Payer: Multiplan Commercial |
$4,107.20
|
| Rate for Payer: Networks By Design Commercial |
$3,337.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,080.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,080.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,567.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,567.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,567.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,567.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,363.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,363.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,363.90
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$5,134.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,026.80 |
| Max. Negotiated Rate |
$4,363.90 |
| Rate for Payer: Adventist Health Commercial |
$1,026.80
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,053.60
|
| Rate for Payer: Galaxy Health WC |
$4,363.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,080.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,424.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,956.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,177.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.16
|
| Rate for Payer: Multiplan Commercial |
$4,107.20
|
| Rate for Payer: Networks By Design Commercial |
$3,337.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,363.90
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$3,794.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$758.80 |
| Max. Negotiated Rate |
$3,224.90 |
| Rate for Payer: Adventist Health Commercial |
$758.80
|
| Rate for Payer: Cash Price |
$1,707.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,517.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,517.60
|
| Rate for Payer: Galaxy Health WC |
$3,224.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,276.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,530.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,445.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,348.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.56
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: Networks By Design Commercial |
$2,466.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,224.90
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,116.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$78.79 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$623.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,648.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,713.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,337.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cash Price |
$1,402.20
|
| Rate for Payer: Cigna of CA HMO |
$2,025.40
|
| Rate for Payer: Cigna of CA PPO |
$2,305.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,648.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,648.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,648.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,246.40
|
| Rate for Payer: Galaxy Health WC |
$2,648.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,869.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,078.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,928.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,181.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,181.20
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: Networks By Design Commercial |
$2,025.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,648.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,869.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,869.60
|
| 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 |
$2,648.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,648.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,648.60
|
|
