|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
OP
|
$9,669.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,933.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,933.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,218.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,251.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cigna of CA HMO |
$6,284.85
|
| Rate for Payer: Cigna of CA PPO |
$7,155.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,218.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,218.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,218.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,768.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,867.60
|
| Rate for Payer: Galaxy Health WC |
$8,218.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,801.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,139.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,509.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,704.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,768.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,768.30
|
| Rate for Payer: Multiplan Commercial |
$7,735.20
|
| Rate for Payer: Networks By Design Commercial |
$6,284.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,218.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,801.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,801.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,218.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,218.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,218.65
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$9,669.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,933.80 |
| Max. Negotiated Rate |
$8,218.65 |
| Rate for Payer: Adventist Health Commercial |
$1,933.80
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,768.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,867.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,867.60
|
| Rate for Payer: Galaxy Health WC |
$8,218.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,801.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,139.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,704.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.56
|
| Rate for Payer: Multiplan Commercial |
$7,735.20
|
| Rate for Payer: Networks By Design Commercial |
$6,284.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,218.65
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
IP
|
$18,835.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,767.00 |
| Max. Negotiated Rate |
$16,009.75 |
| Rate for Payer: Adventist Health Commercial |
$3,767.00
|
| Rate for Payer: Cash Price |
$8,475.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,184.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,534.00
|
| Rate for Payer: Galaxy Health WC |
$16,009.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,301.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,960.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,112.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,520.40
|
| Rate for Payer: Multiplan Commercial |
$15,068.00
|
| Rate for Payer: Networks By Design Commercial |
$12,242.75
|
| Rate for Payer: Prime Health Services Commercial |
$16,009.75
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
OP
|
$18,835.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$16,261.00 |
| Rate for Payer: Adventist Health Commercial |
$3,767.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,839.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,009.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,359.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,126.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$8,475.75
|
| Rate for Payer: Cash Price |
$8,475.75
|
| Rate for Payer: Cash Price |
$8,475.75
|
| Rate for Payer: Cash Price |
$8,475.75
|
| Rate for Payer: Cigna of CA HMO |
$12,054.40
|
| Rate for Payer: Cigna of CA PPO |
$13,937.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,009.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,009.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,009.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,184.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,534.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,534.00
|
| Rate for Payer: Galaxy Health WC |
$16,009.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,301.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,960.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,837.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,112.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,520.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,184.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,184.50
|
| Rate for Payer: Multiplan Commercial |
$15,068.00
|
| Rate for Payer: Networks By Design Commercial |
$12,242.75
|
| Rate for Payer: Prime Health Services Commercial |
$16,009.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,301.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,301.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,009.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,009.75
|
| Rate for Payer: Vantage Medical Group Senior |
$16,009.75
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$24,171.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,834.20 |
| Max. Negotiated Rate |
$20,545.35 |
| Rate for Payer: Adventist Health Commercial |
$4,834.20
|
| Rate for Payer: Cash Price |
$10,876.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,919.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,668.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,668.40
|
| Rate for Payer: Galaxy Health WC |
$20,545.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,502.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,348.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,260.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,801.04
|
| Rate for Payer: Multiplan Commercial |
$19,336.80
|
| Rate for Payer: Networks By Design Commercial |
$15,711.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,545.35
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$45,181.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$9,036.20 |
| Max. Negotiated Rate |
$38,403.85 |
| Rate for Payer: Adventist Health Commercial |
$9,036.20
|
| Rate for Payer: Cash Price |
$20,331.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,626.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,072.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18,072.40
|
| Rate for Payer: Galaxy Health WC |
$38,403.85
|
| Rate for Payer: Global Benefits Group Commercial |
$27,108.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,689.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,656.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,843.44
|
| Rate for Payer: Multiplan Commercial |
$36,144.80
|
| Rate for Payer: Networks By Design Commercial |
$29,367.65
|
| Rate for Payer: Prime Health Services Commercial |
$38,403.85
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$45,181.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$38,403.85 |
| Rate for Payer: Adventist Health Commercial |
$9,036.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,422.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Cash Price |
$20,331.45
|
| Rate for Payer: Cash Price |
$20,331.45
|
| Rate for Payer: Cash Price |
$20,331.45
|
| Rate for Payer: Cash Price |
$20,331.45
|
| Rate for Payer: Cigna of CA HMO |
$28,915.84
|
| Rate for Payer: Cigna of CA PPO |
$33,433.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31,626.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$38,403.85
|
| Rate for Payer: Global Benefits Group Commercial |
$27,108.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,689.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,400.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,843.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$36,144.80
|
| Rate for Payer: Networks By Design Commercial |
$29,367.65
|
| Rate for Payer: Prime Health Services Commercial |
$38,403.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27,108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27,108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$24,171.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$811.52 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,834.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Cash Price |
$10,876.95
|
| Rate for Payer: Cash Price |
$10,876.95
|
| Rate for Payer: Cash Price |
$10,876.95
|
| Rate for Payer: Cigna of CA HMO |
$15,711.15
|
| Rate for Payer: Cigna of CA PPO |
$17,886.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,919.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$20,545.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,502.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$811.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,348.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$917.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,801.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$19,336.80
|
| Rate for Payer: Networks By Design Commercial |
$15,711.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,545.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,502.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,502.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,085.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC CORONARY STENT TWO OR MORE VESSELS
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
906811866
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$48,836.75 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,789.20
|
| Rate for Payer: Multiplan Commercial |
$45,964.00
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC CORONARY STENT TWO OR MORE VESSELS
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
906811866
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$48,836.75 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,868.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cigna of CA HMO |
$37,345.75
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,789.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$45,964.00
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$8,003.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,600.60 |
| Max. Negotiated Rate |
$6,802.55 |
| Rate for Payer: Adventist Health Commercial |
$1,600.60
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,602.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,201.20
|
| Rate for Payer: Galaxy Health WC |
$6,802.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,801.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,081.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,721.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.72
|
| Rate for Payer: Multiplan Commercial |
$6,402.40
|
| Rate for Payer: Networks By Design Commercial |
$5,201.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,802.55
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$8,003.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,600.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,802.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,401.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,002.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: Cash Price |
$3,601.35
|
| Rate for Payer: Cigna of CA HMO |
$5,201.95
|
| Rate for Payer: Cigna of CA PPO |
$5,922.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,802.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,802.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,802.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,602.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,201.20
|
| Rate for Payer: Galaxy Health WC |
$6,802.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,801.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,081.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,721.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,602.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,602.10
|
| Rate for Payer: Multiplan Commercial |
$6,402.40
|
| Rate for Payer: Networks By Design Commercial |
$5,201.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,802.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,001.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,802.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,802.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6,802.55
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
OP
|
$7,274.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,454.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: Cigna of CA HMO |
$4,655.36
|
| Rate for Payer: Cigna of CA PPO |
$5,382.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,091.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$6,182.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,364.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,618.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,873.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,745.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$5,819.20
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$4,728.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,182.90
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,364.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,637.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,637.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,637.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,637.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
IP
|
$7,274.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,454.80 |
| Max. Negotiated Rate |
$6,182.90 |
| Rate for Payer: Adventist Health Commercial |
$1,454.80
|
| Rate for Payer: Cash Price |
$3,273.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,091.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,909.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,909.60
|
| Rate for Payer: Galaxy Health WC |
$6,182.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,364.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,618.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,291.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,745.76
|
| Rate for Payer: Multiplan Commercial |
$5,819.20
|
| Rate for Payer: Networks By Design Commercial |
$4,728.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,182.90
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$1,267.87 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,267.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.15
|
| Rate for Payer: Blue Shield of California Commercial |
$319.54
|
| Rate for Payer: Blue Shield of California Commercial |
$484.24
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO |
$485.76
|
| Rate for Payer: Cigna of CA PPO |
$561.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$531.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$481.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$531.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$481.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
|
|
HC CORTISOL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$168.44 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.44
|
| Rate for Payer: Blue Shield of California Commercial |
$136.46
|
| Rate for Payer: Blue Shield of California Commercial |
$59.01
|
| Rate for Payer: Blue Shield of California Commercial |
$206.31
|
| Rate for Payer: Blue Shield of California Commercial |
$89.22
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$189.44
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$219.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.89
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Senior |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
|
|
HC CORTISOL
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
|
|
HC COUGH ASSIST
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.21
|
| Rate for Payer: Blue Shield of California Commercial |
$210.08
|
| Rate for Payer: Blue Shield of California Commercial |
$318.36
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC COUGH ASSIST
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$424.15 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.76
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$41.03
|
| Rate for Payer: Blue Shield of California Commercial |
$59.47
|
| Rate for Payer: Blue Shield of California Commercial |
$62.03
|
| Rate for Payer: Blue Shield of California Commercial |
$89.91
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO |
$56.96
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Cigna of CA PPO |
$65.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.85
|
| Rate for Payer: EPIC Health Plan Senior |
$19.90
|
| Rate for Payer: EPIC Health Plan Senior |
$19.90
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$109.65 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC COVID19 RNA STAT
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
|
HC COVID19 RNA STAT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$372.39 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.39
|
| Rate for Payer: Blue Shield of California Commercial |
$170.57
|
| Rate for Payer: Blue Shield of California Commercial |
$121.70
|
| Rate for Payer: Blue Shield of California Commercial |
$257.89
|
| Rate for Payer: Blue Shield of California Commercial |
$184.01
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$168.96
|
| Rate for Payer: Cigna of CA PPO |
$195.36
|
| Rate for Payer: Cigna of CA PPO |
$273.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$184.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$167.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$234.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC COVID19 SCREEN POOL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912262
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$328.10 |
| Rate for Payer: Adventist Health Commercial |
$77.20
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$270.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.40
|
| Rate for Payer: EPIC Health Plan Senior |
$154.40
|
| Rate for Payer: Galaxy Health WC |
$328.10
|
| Rate for Payer: Global Benefits Group Commercial |
$231.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$245.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.64
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Networks By Design Commercial |
$250.90
|
| Rate for Payer: Prime Health Services Commercial |
$328.10
|
|
