|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Media |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$109.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
IP
|
$146.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
OP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,272.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$696.46
|
| Rate for Payer: Blue Shield of California EPN |
$551.88
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$708.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: IEHP Medi-Cal |
$649.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$649.33
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO |
$472.50
|
| Rate for Payer: United Healthcare HMO Rider |
$472.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$472.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
OP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,272.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$696.46
|
| Rate for Payer: Blue Shield of California EPN |
$551.88
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$708.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: IEHP Medi-Cal |
$649.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$649.33
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
IP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
IP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
OP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,272.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$696.46
|
| Rate for Payer: Blue Shield of California EPN |
$551.88
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$708.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$657.34
|
| Rate for Payer: IEHP Medi-Cal |
$649.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$649.33
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO |
$472.50
|
| Rate for Payer: United Healthcare HMO Rider |
$472.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$472.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
IP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
OP
|
$5,252.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,151.20
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cigna of CA PPO |
$3,886.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,464.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,151.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,939.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: IEHP Medi-Cal |
$3,281.62
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,669.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,151.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$6,595.60
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,800.00
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$6,595.60
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,800.00
|
| 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: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,255.70
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$371.89
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$371.89
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$250.00
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$8,408.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,440.60
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$5,935.20
|
| 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'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 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: AlphaCare Medical Group Commercial/Exchange |
$23,888.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,457.20
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: Redlands Yucaipa Medical Group Commercial/Senior |
$16,862.40
|
| 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
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 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: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$14,836.80
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$27,732.60
|
| 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 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
|
|
