|
HC CONG R & L HEART W SEPTAL
|
Facility
|
IP
|
$8,882.00
|
|
|
Service Code
|
CPT 93533
|
| Hospital Charge Code |
906811253
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,776.40 |
| Max. Negotiated Rate |
$7,549.70 |
| Rate for Payer: Adventist Health Commercial |
$1,776.40
|
| Rate for Payer: Cash Price |
$3,996.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,552.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,552.80
|
| Rate for Payer: Galaxy Health WC |
$7,549.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,329.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,924.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,384.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,497.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.68
|
| Rate for Payer: Multiplan Commercial |
$7,105.60
|
| Rate for Payer: Networks By Design Commercial |
$5,773.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,549.70
|
|
|
HC CONG R & L HEART W SEPTAL
|
Facility
|
OP
|
$8,882.00
|
|
|
Service Code
|
CPT 93533
|
| Hospital Charge Code |
906811253
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,776.40 |
| Max. Negotiated Rate |
$15,561.00 |
| Rate for Payer: Adventist Health Commercial |
$1,776.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,549.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,885.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,661.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,996.90
|
| Rate for Payer: Cash Price |
$3,996.90
|
| Rate for Payer: Cigna of CA HMO |
$5,773.30
|
| Rate for Payer: Cigna of CA PPO |
$6,572.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,549.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,549.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,549.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,552.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,552.80
|
| Rate for Payer: Galaxy Health WC |
$7,549.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,329.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,924.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,384.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,497.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,217.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,217.40
|
| Rate for Payer: Multiplan Commercial |
$7,105.60
|
| Rate for Payer: Networks By Design Commercial |
$5,773.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,549.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,329.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,329.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,441.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,441.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,441.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,549.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,549.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7,549.70
|
|
|
HC CONG R & L HEART W TRANSEPTAL
|
Facility
|
OP
|
$8,035.00
|
|
|
Service Code
|
CPT 93532
|
| Hospital Charge Code |
906811252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,607.00 |
| Max. Negotiated Rate |
$15,561.00 |
| Rate for Payer: Adventist Health Commercial |
$1,607.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,419.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,026.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: Cigna of CA HMO |
$5,222.75
|
| Rate for Payer: Cigna of CA PPO |
$5,945.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,829.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,829.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,214.00
|
| Rate for Payer: Galaxy Health WC |
$6,829.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,821.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,359.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,061.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,973.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,624.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,624.50
|
| Rate for Payer: Multiplan Commercial |
$6,428.00
|
| Rate for Payer: Networks By Design Commercial |
$5,222.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,829.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,821.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,821.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,017.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,017.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,017.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,017.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,829.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,829.75
|
|
|
HC CONG R & L HEART W TRANSEPTAL
|
Facility
|
IP
|
$8,035.00
|
|
|
Service Code
|
CPT 93532
|
| Hospital Charge Code |
906811252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,607.00 |
| Max. Negotiated Rate |
$6,829.75 |
| Rate for Payer: Adventist Health Commercial |
$1,607.00
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,214.00
|
| Rate for Payer: Galaxy Health WC |
$6,829.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,821.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,359.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,061.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,973.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.40
|
| Rate for Payer: Multiplan Commercial |
$6,428.00
|
| Rate for Payer: Networks By Design Commercial |
$5,222.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,829.75
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$5,679.70 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,672.80
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,545.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,136.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cigna of CA HMO |
$4,343.30
|
| Rate for Payer: Cigna of CA PPO |
$4,944.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
OP
|
$6,876.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906811597
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cigna of CA HMO |
$4,469.40
|
| Rate for Payer: Cigna of CA PPO |
$5,088.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cigna of CA HMO |
$4,343.30
|
| Rate for Payer: Cigna of CA PPO |
$4,944.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
IP
|
$6,876.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906811597
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$5,844.60 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.40
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,619.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,256.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
|
|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$5,679.70 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,672.80
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,545.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,136.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
IP
|
$6,876.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906811596
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$5,844.60 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.40
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,619.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,256.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906820093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cigna of CA HMO |
$4,343.30
|
| Rate for Payer: Cigna of CA PPO |
$4,944.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906820093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$5,679.70 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,672.80
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,545.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,136.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
|
OP
|
$6,876.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906811596
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cigna of CA HMO |
$4,469.40
|
| Rate for Payer: Cigna of CA PPO |
$5,088.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT HEART CATH ABNL NAT
|
Facility
|
OP
|
$6,876.00
|
|
|
Service Code
|
CPT 93594
|
| Hospital Charge Code |
906811594
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cigna of CA HMO |
$4,469.40
|
| Rate for Payer: Cigna of CA PPO |
$5,088.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT HEART CATH ABNL NAT
|
Facility
|
IP
|
$6,876.00
|
|
|
Service Code
|
CPT 93594
|
| Hospital Charge Code |
906811594
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$5,844.60 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.40
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,619.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,256.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
|
IP
|
$6,682.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906820095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$5,679.70 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,672.80
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,545.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,136.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
|
OP
|
$6,876.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906811593
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: Cigna of CA HMO |
$4,469.40
|
| Rate for Payer: Cigna of CA PPO |
$5,088.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,125.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,125.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
|
OP
|
$6,682.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906820095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,336.40 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,336.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cash Price |
$3,006.90
|
| Rate for Payer: Cigna of CA HMO |
$4,343.30
|
| Rate for Payer: Cigna of CA PPO |
$4,944.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$5,679.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,009.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,456.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,603.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$5,345.60
|
| Rate for Payer: Networks By Design Commercial |
$4,343.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,679.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
|
IP
|
$6,876.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906811593
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.20 |
| Max. Negotiated Rate |
$5,844.60 |
| Rate for Payer: Adventist Health Commercial |
$1,375.20
|
| Rate for Payer: Cash Price |
$3,094.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.40
|
| Rate for Payer: Galaxy Health WC |
$5,844.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,586.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,619.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,256.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.24
|
| Rate for Payer: Multiplan Commercial |
$5,500.80
|
| Rate for Payer: Networks By Design Commercial |
$4,469.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,844.60
|
|
|
HC CONSULT COMP/HIGH COMPLEX
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
908600122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$1,030.20 |
| Rate for Payer: Adventist Health Commercial |
$242.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.80
|
| Rate for Payer: EPIC Health Plan Senior |
$484.80
|
| Rate for Payer: Galaxy Health WC |
$1,030.20
|
| Rate for Payer: Global Benefits Group Commercial |
$727.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$808.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$750.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.88
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: Networks By Design Commercial |
$787.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,030.20
|
|
|
HC CONSULT COMP/HIGH COMPLEX
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
908600122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$1,030.20 |
| Rate for Payer: Adventist Health Commercial |
$242.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$794.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,030.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$666.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$909.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$744.29
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna of CA HMO |
$775.68
|
| Rate for Payer: Cigna of CA PPO |
$896.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,030.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,030.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.80
|
| Rate for Payer: EPIC Health Plan Senior |
$484.80
|
| Rate for Payer: Galaxy Health WC |
$1,030.20
|
| Rate for Payer: Global Benefits Group Commercial |
$727.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$808.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$750.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$848.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$848.40
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: Networks By Design Commercial |
$787.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,030.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$727.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$606.00
|
| Rate for Payer: United Healthcare All Other HMO |
$606.00
|
| Rate for Payer: United Healthcare HMO Rider |
$606.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,030.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,030.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,030.20
|
|
|
HC CONSULT COMP/HIGH COMPLEX
|
Facility
|
OP
|
$1,019.00
|
|
| Hospital Charge Code |
912999245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$668.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$560.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.77
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: Cigna of CA HMO |
$652.16
|
| Rate for Payer: Cigna of CA PPO |
$754.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$866.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$866.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$866.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$630.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$713.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$713.30
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$611.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$611.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.50
|
| Rate for Payer: United Healthcare All Other HMO |
$509.50
|
| Rate for Payer: United Healthcare HMO Rider |
$509.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$866.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$866.15
|
| Rate for Payer: Vantage Medical Group Senior |
$866.15
|
|
|
HC CONSULT COMP/HIGH COMPLEX
|
Facility
|
IP
|
$1,019.00
|
|
| Hospital Charge Code |
912999245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.80 |
| Max. Negotiated Rate |
$866.15 |
| Rate for Payer: Adventist Health Commercial |
$203.80
|
| Rate for Payer: Cash Price |
$458.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$407.60
|
| Rate for Payer: EPIC Health Plan Senior |
$407.60
|
| Rate for Payer: Galaxy Health WC |
$866.15
|
| Rate for Payer: Global Benefits Group Commercial |
$611.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$630.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.56
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: Networks By Design Commercial |
$662.35
|
| Rate for Payer: Prime Health Services Commercial |
$866.15
|
|
|
HC CONSULT COMP/MOD COMPLEX
|
Facility
|
IP
|
$897.00
|
|
| Hospital Charge Code |
912999244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$762.45 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
