|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$141.93 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$196.65 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$619.08
|
| Rate for Payer: Blue Shield of California EPN |
$490.56
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,300.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$672.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
IP
|
$5,531.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,327.44 |
| Max. Negotiated Rate |
$4,701.35 |
| Rate for Payer: Cash Price |
$2,488.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,212.40
|
| Rate for Payer: Galaxy Health WC |
$4,701.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,689.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.44
|
| Rate for Payer: Multiplan Commercial |
$4,424.80
|
| Rate for Payer: Networks By Design Commercial |
$3,595.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,701.35
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
OP
|
$5,531.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.89 |
| Max. Negotiated Rate |
$4,701.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$570.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,176.44
|
| Rate for Payer: Blue Distinction Transplant |
$3,318.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,268.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,594.04
|
| Rate for Payer: Cash Price |
$2,488.95
|
| Rate for Payer: Cash Price |
$2,488.95
|
| Rate for Payer: Cigna of CA HMO |
$3,539.84
|
| Rate for Payer: Cigna of CA PPO |
$4,092.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$4,701.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,318.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,148.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,689.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$4,424.80
|
| Rate for Payer: Networks By Design Commercial |
$3,595.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,701.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,318.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,318.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
IP
|
$8,054.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,932.96 |
| Max. Negotiated Rate |
$6,845.90 |
| Rate for Payer: Cash Price |
$3,624.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,221.60
|
| Rate for Payer: Galaxy Health WC |
$6,845.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,832.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,372.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,068.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.96
|
| Rate for Payer: Multiplan Commercial |
$6,443.20
|
| Rate for Payer: Networks By Design Commercial |
$5,235.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,845.90
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
OP
|
$8,054.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.21 |
| Max. Negotiated Rate |
$6,845.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$561.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,038.23
|
| Rate for Payer: Blue Distinction Transplant |
$4,832.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,759.91
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.33
|
| Rate for Payer: Cash Price |
$3,624.30
|
| Rate for Payer: Cash Price |
$3,624.30
|
| Rate for Payer: Cigna of CA HMO |
$5,154.56
|
| Rate for Payer: Cigna of CA PPO |
$5,959.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$6,845.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,832.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,040.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,372.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$6,443.20
|
| Rate for Payer: Networks By Design Commercial |
$5,235.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,845.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,832.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,832.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC DISK ASPIRATION
|
Facility
|
OP
|
$16,121.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,414.74 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,672.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$7,254.45
|
| Rate for Payer: Cash Price |
$7,254.45
|
| Rate for Payer: Cigna of CA PPO |
$11,929.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$13,702.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,090.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,869.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$12,896.80
|
| Rate for Payer: Networks By Design Commercial |
$10,478.65
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.60
|
| 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 |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC DISK ASPIRATION
|
Facility
|
IP
|
$16,121.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,869.04 |
| Max. Negotiated Rate |
$13,702.85 |
| Rate for Payer: Cash Price |
$7,254.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.40
|
| Rate for Payer: Galaxy Health WC |
$13,702.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,142.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,869.04
|
| Rate for Payer: Multiplan Commercial |
$12,896.80
|
| Rate for Payer: Networks By Design Commercial |
$10,478.65
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.85
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$553.35 |
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.24
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$553.35 |
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.24
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$390.60
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cigna of CA PPO |
$481.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$488.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| 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 |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$325.50
|
| Rate for Payer: United Healthcare All Other HMO |
$325.50
|
| Rate for Payer: United Healthcare HMO Rider |
$325.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$633.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$390.60
|
| 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 |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cigna of CA PPO |
$481.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$488.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.60
|
| 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 |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$125.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.37
|
| Rate for Payer: Blue Distinction Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$10.75
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Media |
$13.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.53
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
