|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,260.48 |
| Max. Negotiated Rate |
$4,464.20 |
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,100.80
|
| Rate for Payer: Galaxy Health WC |
$4,464.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.48
|
| Rate for Payer: Multiplan Commercial |
$4,201.60
|
| Rate for Payer: Networks By Design Commercial |
$3,413.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,464.20
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$17,317.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,496.54 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,141.76
|
| 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 |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,390.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Cigna of CA PPO |
$12,814.58
|
| 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 |
$14,719.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,390.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,987.75
|
| 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 |
$11,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,496.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,156.08
|
| 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 |
$13,853.60
|
| Rate for Payer: Networks By Design Commercial |
$11,256.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,719.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,390.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$17,317.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,156.08 |
| Max. Negotiated Rate |
$14,719.45 |
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,926.80
|
| Rate for Payer: Galaxy Health WC |
$14,719.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,390.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,597.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,156.08
|
| Rate for Payer: Multiplan Commercial |
$13,853.60
|
| Rate for Payer: Networks By Design Commercial |
$11,256.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,719.45
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
IP
|
$14,820.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,556.80 |
| Max. Negotiated Rate |
$12,597.00 |
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,928.00
|
| Rate for Payer: Galaxy Health WC |
$12,597.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,892.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,646.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$11,856.00
|
| Rate for Payer: Networks By Design Commercial |
$9,633.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,597.00
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
OP
|
$14,820.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,747.03 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,535.19
|
| 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 |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,892.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Cigna of CA PPO |
$10,966.80
|
| 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 |
$12,597.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,892.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,115.00
|
| 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 |
$9,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,747.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,556.80
|
| 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 |
$11,856.00
|
| Rate for Payer: Networks By Design Commercial |
$9,633.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,597.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,892.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 CORONARY CTA W/MORPH W/O CCS
|
Facility
|
OP
|
$3,786.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,218.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| 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 |
$2,255.70
|
| Rate for Payer: Blue Distinction Transplant |
$2,271.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,237.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,775.63
|
| Rate for Payer: Cash Price |
$1,703.70
|
| Rate for Payer: Cash Price |
$1,703.70
|
| Rate for Payer: Cigna of CA HMO |
$2,423.04
|
| Rate for Payer: Cigna of CA PPO |
$2,801.64
|
| 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 |
$3,218.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,839.50
|
| 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 |
$2,525.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$908.64
|
| 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 |
$3,028.80
|
| Rate for Payer: Networks By Design Commercial |
$2,460.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,218.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,271.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| 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 CORONARY CTA W/MORPH W/O CCS
|
Facility
|
IP
|
$5,396.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,295.04 |
| Max. Negotiated Rate |
$4,586.60 |
| Rate for Payer: Cash Price |
$2,428.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,158.40
|
| Rate for Payer: Galaxy Health WC |
$4,586.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,599.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,055.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.04
|
| Rate for Payer: Multiplan Commercial |
$4,316.80
|
| Rate for Payer: Networks By Design Commercial |
$3,507.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,586.60
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$9,892.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,374.08 |
| Max. Negotiated Rate |
$8,408.20 |
| Rate for Payer: Cash Price |
$4,451.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.80
|
| Rate for Payer: Galaxy Health WC |
$8,408.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,935.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,768.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,374.08
|
| Rate for Payer: Multiplan Commercial |
$7,913.60
|
| Rate for Payer: Networks By Design Commercial |
$6,429.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,408.20
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
OP
|
$9,892.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,374.08 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,607.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,408.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,440.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,440.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,935.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$4,451.40
|
| Rate for Payer: Cash Price |
$4,451.40
|
| Rate for Payer: Cigna of CA PPO |
$7,320.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,408.20
|
| Rate for Payer: Dignity Health Media |
$8,408.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,408.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,956.80
|
| Rate for Payer: Galaxy Health WC |
$8,408.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,935.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,419.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,374.08
|
| Rate for Payer: Multiplan Commercial |
$7,913.60
|
| Rate for Payer: Networks By Design Commercial |
$6,429.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,408.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,935.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,935.20
|
| 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 |
$8,408.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,408.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8,408.20
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
IP
|
$28,104.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,744.96 |
| Max. Negotiated Rate |
$23,888.40 |
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,241.60
|
| Rate for Payer: Galaxy Health WC |
$23,888.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16,862.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,745.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,707.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,744.96
|
| Rate for Payer: Multiplan Commercial |
$22,483.20
|
| Rate for Payer: Networks By Design Commercial |
$18,267.60
|
| Rate for Payer: Prime Health Services Commercial |
$23,888.40
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
OP
|
$28,104.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$23,888.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,839.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,888.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,457.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,457.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$16,862.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: Cigna of CA HMO |
$17,986.56
|
| Rate for Payer: Cigna of CA PPO |
$20,796.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,888.40
|
| Rate for Payer: Dignity Health Media |
$23,888.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,888.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,241.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,241.60
|
| Rate for Payer: Galaxy Health WC |
$23,888.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16,862.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21,078.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,745.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,707.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,744.96
|
| Rate for Payer: Multiplan Commercial |
$22,483.20
|
| Rate for Payer: Networks By Design Commercial |
$18,267.60
|
| Rate for Payer: Prime Health Services Commercial |
$23,888.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,862.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,862.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,888.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,888.40
|
| Rate for Payer: Vantage Medical Group Senior |
$23,888.40
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$46,221.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$39,287.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,422.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$27,732.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$20,799.45
|
| Rate for Payer: Cash Price |
$20,799.45
|
| Rate for Payer: Cash Price |
$20,799.45
|
| Rate for Payer: Cigna of CA HMO |
$29,581.44
|
| Rate for Payer: Cigna of CA PPO |
$34,203.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$39,287.85
|
| Rate for Payer: Global Benefits Group Commercial |
$27,732.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34,665.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,829.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,610.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,093.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$36,976.80
|
| Rate for Payer: Networks By Design Commercial |
$30,043.65
|
| Rate for Payer: Prime Health Services Commercial |
$39,287.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27,732.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,732.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$24,728.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$917.80 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,757.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$14,836.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: Cigna of CA PPO |
$18,298.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$21,018.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14,836.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,546.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,934.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$19,782.40
|
| Rate for Payer: Networks By Design Commercial |
$16,073.20
|
| Rate for Payer: Prime Health Services Commercial |
$21,018.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,836.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,836.80
|
| 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 |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$46,221.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,093.04 |
| Max. Negotiated Rate |
$39,287.85 |
| Rate for Payer: Cash Price |
$20,799.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,488.40
|
| Rate for Payer: Galaxy Health WC |
$39,287.85
|
| Rate for Payer: Global Benefits Group Commercial |
$27,732.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,829.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,610.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,093.04
|
| Rate for Payer: Multiplan Commercial |
$36,976.80
|
| Rate for Payer: Networks By Design Commercial |
$30,043.65
|
| Rate for Payer: Prime Health Services Commercial |
$39,287.85
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$24,728.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,934.72 |
| Max. Negotiated Rate |
$21,018.80 |
| Rate for Payer: Cash Price |
$11,127.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,891.20
|
| Rate for Payer: Galaxy Health WC |
$21,018.80
|
| Rate for Payer: Global Benefits Group Commercial |
$14,836.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,421.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,934.72
|
| Rate for Payer: Multiplan Commercial |
$19,782.40
|
| Rate for Payer: Networks By Design Commercial |
$16,073.20
|
| Rate for Payer: Prime Health Services Commercial |
$21,018.80
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$8,187.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,964.88 |
| Max. Negotiated Rate |
$6,958.95 |
| Rate for Payer: Cash Price |
$3,684.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,274.80
|
| Rate for Payer: Galaxy Health WC |
$6,958.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,912.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,460.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,119.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,964.88
|
| Rate for Payer: Multiplan Commercial |
$6,549.60
|
| Rate for Payer: Networks By Design Commercial |
$5,321.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,958.95
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$8,187.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$8,241.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,192.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,958.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,502.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,502.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,912.20
|
| 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 |
$3,684.15
|
| Rate for Payer: Cash Price |
$3,684.15
|
| Rate for Payer: Cash Price |
$3,684.15
|
| Rate for Payer: Cigna of CA PPO |
$6,058.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,958.95
|
| Rate for Payer: Dignity Health Media |
$6,958.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,958.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,274.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,274.80
|
| Rate for Payer: Galaxy Health WC |
$6,958.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,912.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,140.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,460.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,964.88
|
| Rate for Payer: Multiplan Commercial |
$6,549.60
|
| Rate for Payer: Networks By Design Commercial |
$5,321.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,958.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,912.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,912.20
|
| 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 |
$6,958.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,958.95
|
| Rate for Payer: Vantage Medical Group Senior |
$6,958.95
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
OP
|
$9,009.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,405.40
|
| Rate for Payer: Cash Price |
$4,054.05
|
| Rate for Payer: Cash Price |
$4,054.05
|
| Rate for Payer: Cash Price |
$4,054.05
|
| Rate for Payer: Cigna of CA PPO |
$6,666.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$7,657.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,405.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,756.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| 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 |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,009.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$7,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,855.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,657.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,405.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,504.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,504.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,504.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,504.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
IP
|
$9,009.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,162.16 |
| Max. Negotiated Rate |
$7,657.65 |
| Rate for Payer: Cash Price |
$4,054.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,603.60
|
| Rate for Payer: Galaxy Health WC |
$7,657.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,405.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,009.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,432.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.16
|
| Rate for Payer: Multiplan Commercial |
$7,207.20
|
| Rate for Payer: Networks By Design Commercial |
$5,855.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,657.65
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.92 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$1,120.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,120.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.25
|
| Rate for Payer: Blue Distinction Transplant |
$484.80
|
| Rate for Payer: Blue Shield of California Commercial |
$477.53
|
| Rate for Payer: Blue Shield of California EPN |
$378.95
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna of CA HMO |
$517.12
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CORTISOL
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$148.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$135.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.89
|
| Rate for Payer: Blue Distinction Transplant |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34.88
|
| Rate for Payer: Blue Shield of California EPN |
$27.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Media |
$16.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$206.88 |
| Max. Negotiated Rate |
$732.70 |
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.80
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.88
|
| Rate for Payer: Multiplan Commercial |
$689.60
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$206.88 |
| Max. Negotiated Rate |
$5,217.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,217.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$964.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$707.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.58
|
| Rate for Payer: Blue Distinction Transplant |
$517.20
|
| Rate for Payer: Blue Shield of California Commercial |
$635.29
|
| Rate for Payer: Blue Shield of California EPN |
$503.41
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna of CA HMO |
$551.68
|
| Rate for Payer: Cigna of CA PPO |
$637.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$964.10
|
| Rate for Payer: Dignity Health Media |
$642.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$707.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$642.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$642.73
|
| Rate for Payer: Galaxy Health WC |
$732.70
|
| Rate for Payer: Global Benefits Group Commercial |
$517.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$646.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,054.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,054.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,041.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,041.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$642.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$574.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$642.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$809.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.26
|
| Rate for Payer: Multiplan Commercial |
$689.60
|
| Rate for Payer: Networks By Design Commercial |
$560.30
|
| Rate for Payer: Prime Health Services Commercial |
$732.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$517.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$517.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$964.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$707.00
|
| Rate for Payer: Vantage Medical Group Senior |
$642.73
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$118.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.12
|
| Rate for Payer: Blue Distinction Transplant |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$43.28
|
| Rate for Payer: Blue Shield of California EPN |
$34.30
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Media |
$18.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
