|
HC COLON W SNGL CONTRAST ENEMA
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
909001806
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$1,430.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$553.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.49
|
| Rate for Payer: Blue Distinction Transplant |
$1,009.80
|
| Rate for Payer: Blue Shield of California Commercial |
$994.65
|
| Rate for Payer: Blue Shield of California EPN |
$789.33
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cigna of CA HMO |
$1,077.12
|
| Rate for Payer: Cigna of CA PPO |
$1,245.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,262.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,346.40
|
| Rate for Payer: Networks By Design Commercial |
$1,093.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC COLPORRHAPHY
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$571.94 |
| Max. Negotiated Rate |
$6,406.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,287.40
|
| Rate for Payer: Cash Price |
$2,465.55
|
| Rate for Payer: Cash Price |
$2,465.55
|
| Rate for Payer: Cash Price |
$2,465.55
|
| Rate for Payer: Cigna of CA PPO |
$4,054.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$4,657.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,287.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,109.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,654.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$571.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: Networks By Design Commercial |
$3,561.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,657.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,287.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,739.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,739.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC COLPORRHAPHY
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
900501301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,314.96 |
| Max. Negotiated Rate |
$4,657.15 |
| Rate for Payer: Cash Price |
$2,465.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,191.60
|
| Rate for Payer: Galaxy Health WC |
$4,657.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,287.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,654.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,087.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.96
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: Networks By Design Commercial |
$3,561.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,657.15
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.48 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$436.20
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cigna of CA PPO |
$537.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$545.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$649.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$480.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$329.28 |
| Max. Negotiated Rate |
$1,166.20 |
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.80
|
| Rate for Payer: Galaxy Health WC |
$1,166.20
|
| Rate for Payer: Global Benefits Group Commercial |
$823.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.28
|
| Rate for Payer: Multiplan Commercial |
$1,097.60
|
| Rate for Payer: Networks By Design Commercial |
$891.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,166.20
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.48 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$436.20
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cigna of CA PPO |
$537.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$617.95
|
| Rate for Payer: Global Benefits Group Commercial |
$436.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$545.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: Networks By Design Commercial |
$472.55
|
| Rate for Payer: Prime Health Services Commercial |
$617.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$436.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$363.50
|
| Rate for Payer: United Healthcare All Other HMO |
$363.50
|
| Rate for Payer: United Healthcare HMO Rider |
$363.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$363.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC COLPOSCOPY VAG W CRVIX
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
906757420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.28 |
| Max. Negotiated Rate |
$1,166.20 |
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.80
|
| Rate for Payer: Galaxy Health WC |
$1,166.20
|
| Rate for Payer: Global Benefits Group Commercial |
$823.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.28
|
| Rate for Payer: Multiplan Commercial |
$1,097.60
|
| Rate for Payer: Networks By Design Commercial |
$891.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,166.20
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
IP
|
$10,387.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,492.88 |
| Max. Negotiated Rate |
$8,828.95 |
| Rate for Payer: Cash Price |
$4,674.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,154.80
|
| Rate for Payer: Galaxy Health WC |
$8,828.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,232.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,928.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,957.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,492.88
|
| Rate for Payer: Multiplan Commercial |
$8,309.60
|
| Rate for Payer: Networks By Design Commercial |
$6,751.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,828.95
|
|
|
HC COMMON CAROTID HEAD UNI
|
Facility
|
OP
|
$10,387.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
909020146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.09 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,232.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,674.15
|
| Rate for Payer: Cash Price |
$4,674.15
|
| Rate for Payer: Cigna of CA PPO |
$7,686.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$8,828.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,232.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,790.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,928.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,492.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$8,309.60
|
| Rate for Payer: Networks By Design Commercial |
$6,751.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,828.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
IP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
909020145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,368.32 |
| Max. Negotiated Rate |
$8,387.80 |
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,947.20
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,581.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,759.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,368.32
|
| Rate for Payer: Multiplan Commercial |
$7,894.40
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
|
|
HC COMMON CAROTID NECK UNI
|
Facility
|
OP
|
$9,868.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
909020145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.01 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,920.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cash Price |
$4,440.60
|
| Rate for Payer: Cigna of CA PPO |
$7,302.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$8,387.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,920.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,401.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,581.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,368.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,894.40
|
| Rate for Payer: Networks By Design Commercial |
$6,414.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,387.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,920.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$132.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$166.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna of CA HMO |
$177.92
|
| Rate for Payer: Cigna of CA PPO |
$205.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$236.30
|
| Rate for Payer: Dignity Health Media |
$236.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$236.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$208.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$236.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$236.30
|
| Rate for Payer: Vantage Medical Group Senior |
$236.30
|
|
|
HC COMM/WORK REINTEGRATION 15 MIN MCAL
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
901300068
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$185.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC COMPLEMENT C-3
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$109.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.52
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Media |
$12.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$19.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT C-4
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900910979
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$109.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.52
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Media |
$12.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$19.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC COMPLEMENT TOTAL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900910842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$185.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$168.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.32
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.76
|
| Rate for Payer: Blue Shield of California EPN |
$30.72
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Media |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.32
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC COMPREHENSIVE METABOLIC PANEL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
900910423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$96.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.56
|
| Rate for Payer: Blue Distinction Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.80
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.84
|
| Rate for Payer: Dignity Health Media |
$10.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.56
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$17.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$17.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.15
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.55
|
| Rate for Payer: United Healthcare All Other HMO |
$8.55
|
| Rate for Payer: United Healthcare HMO Rider |
$8.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.62
|
| Rate for Payer: Vantage Medical Group Senior |
$10.56
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906811595
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,220.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA PPO |
$5,205.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,275.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CONG LT HEART CATH NML OR ABNL
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
CPT 93595
|
| Hospital Charge Code |
906811595
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$5,978.90 |
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,813.60
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,679.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906811597
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,220.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA PPO |
$5,205.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,275.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906811597
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$5,978.90 |
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,813.60
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,679.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906811596
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$5,978.90 |
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,813.60
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,679.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906811596
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,220.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA PPO |
$5,205.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,275.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CONG RT HEART CATH ABNL NAT
|
Facility
|
IP
|
$7,034.00
|
|
|
Service Code
|
CPT 93594
|
| Hospital Charge Code |
906811594
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$5,978.90 |
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,813.60
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,679.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
|
|
HC CONG RT HEART CATH ABNL NAT
|
Facility
|
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93594
|
| Hospital Charge Code |
906811594
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,688.16 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,220.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA PPO |
$5,205.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$5,978.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,220.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,275.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,691.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$5,627.20
|
| Rate for Payer: Networks By Design Commercial |
$4,572.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,978.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
