|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$2,319.65 |
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$2,319.65 |
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.49 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,500.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,500.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,637.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA PPO |
$2,019.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Dignity Health Media |
$2,319.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,319.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,046.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,637.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,319.65
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
OP
|
$4,493.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,695.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cigna of CA PPO |
$3,324.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,369.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,695.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
IP
|
$4,493.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,078.32 |
| Max. Negotiated Rate |
$3,819.05 |
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,797.20
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,711.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
OP
|
$4,493.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.15 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,695.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: Cigna of CA PPO |
$3,324.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,369.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,695.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
IP
|
$4,493.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,078.32 |
| Max. Negotiated Rate |
$3,819.05 |
| Rate for Payer: Cash Price |
$2,021.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,797.20
|
| Rate for Payer: Galaxy Health WC |
$3,819.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,695.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,996.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,711.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,078.32
|
| Rate for Payer: Multiplan Commercial |
$3,594.40
|
| Rate for Payer: Networks By Design Commercial |
$2,920.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,819.05
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
IP
|
$24,258.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,821.92 |
| Max. Negotiated Rate |
$20,619.30 |
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,703.20
|
| Rate for Payer: Galaxy Health WC |
$20,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,554.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,242.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,821.92
|
| Rate for Payer: Multiplan Commercial |
$19,406.40
|
| Rate for Payer: Networks By Design Commercial |
$15,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,619.30
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
OP
|
$24,258.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,607.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$14,554.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cigna of CA PPO |
$17,950.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$20,619.30
|
| Rate for Payer: Global Benefits Group Commercial |
$14,554.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,193.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,121.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,821.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$19,406.40
|
| Rate for Payer: Networks By Design Commercial |
$15,767.70
|
| Rate for Payer: Prime Health Services Commercial |
$20,619.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,554.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$23,291.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,985.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,974.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Cigna of CA PPO |
$17,235.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$19,797.35
|
| Rate for Payer: Global Benefits Group Commercial |
$13,974.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17,468.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,535.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,589.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$18,632.80
|
| Rate for Payer: Networks By Design Commercial |
$15,139.15
|
| Rate for Payer: Prime Health Services Commercial |
$19,797.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,974.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$23,291.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,589.84 |
| Max. Negotiated Rate |
$19,797.35 |
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,316.40
|
| Rate for Payer: Galaxy Health WC |
$19,797.35
|
| Rate for Payer: Global Benefits Group Commercial |
$13,974.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,535.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,873.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,589.84
|
| Rate for Payer: Multiplan Commercial |
$18,632.80
|
| Rate for Payer: Networks By Design Commercial |
$15,139.15
|
| Rate for Payer: Prime Health Services Commercial |
$19,797.35
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
OP
|
$25,199.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,213.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Cigna of CA PPO |
$18,647.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$21,419.15
|
| Rate for Payer: Global Benefits Group Commercial |
$15,119.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,899.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,807.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,128.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,047.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$20,159.20
|
| Rate for Payer: Networks By Design Commercial |
$16,379.35
|
| Rate for Payer: Prime Health Services Commercial |
$21,419.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
IP
|
$25,199.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,047.76 |
| Max. Negotiated Rate |
$21,419.15 |
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,079.60
|
| Rate for Payer: Galaxy Health WC |
$21,419.15
|
| Rate for Payer: Global Benefits Group Commercial |
$15,119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,807.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,600.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,047.76
|
| Rate for Payer: Multiplan Commercial |
$20,159.20
|
| Rate for Payer: Networks By Design Commercial |
$16,379.35
|
| Rate for Payer: Prime Health Services Commercial |
$21,419.15
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$17,605.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,225.20 |
| Max. Negotiated Rate |
$14,964.25 |
| Rate for Payer: Cash Price |
$7,922.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,042.00
|
| Rate for Payer: Galaxy Health WC |
$14,964.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,563.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,742.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,707.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,225.20
|
| Rate for Payer: Multiplan Commercial |
$14,084.00
|
| Rate for Payer: Networks By Design Commercial |
$11,443.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,964.25
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$17,605.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,327.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,563.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$7,922.25
|
| Rate for Payer: Cash Price |
$7,922.25
|
| Rate for Payer: Cash Price |
$7,922.25
|
| Rate for Payer: Cigna of CA PPO |
$13,027.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$14,964.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,563.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,203.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,742.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,442.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,225.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$14,084.00
|
| Rate for Payer: Networks By Design Commercial |
$11,443.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,964.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,563.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
OP
|
$16,268.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,466.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,760.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$7,320.60
|
| Rate for Payer: Cash Price |
$7,320.60
|
| Rate for Payer: Cash Price |
$7,320.60
|
| Rate for Payer: Cigna of CA PPO |
$12,038.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$13,827.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,760.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,201.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,850.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,897.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,904.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$13,014.40
|
| Rate for Payer: Networks By Design Commercial |
$10,574.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,827.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,760.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
IP
|
$16,268.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,904.32 |
| Max. Negotiated Rate |
$13,827.80 |
| Rate for Payer: Cash Price |
$7,320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,507.20
|
| Rate for Payer: Galaxy Health WC |
$13,827.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,760.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,850.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,198.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,904.32
|
| Rate for Payer: Multiplan Commercial |
$13,014.40
|
| Rate for Payer: Networks By Design Commercial |
$10,574.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,827.80
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.98
|
| Rate for Payer: Blue Distinction Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12.27
|
| Rate for Payer: Blue Shield of California EPN |
$9.73
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Media |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other HMO |
$4.59
|
| Rate for Payer: United Healthcare HMO Rider |
$4.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.48
|
| Rate for Payer: Blue Distinction Transplant |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$271.20
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$339.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC RIBS BILATERAL
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.44 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.40
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
|
|
HC RIBS BILATERAL
|
Facility
|
OP
|
$1,306.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$176.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.20
|
| Rate for Payer: Blue Distinction Transplant |
$783.60
|
| Rate for Payer: Blue Shield of California Commercial |
$771.85
|
| Rate for Payer: Blue Shield of California EPN |
$612.51
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cigna of CA HMO |
$835.84
|
| Rate for Payer: Cigna of CA PPO |
$966.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$979.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC RIBS UNILATERAL
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.63
|
| Rate for Payer: Blue Distinction Transplant |
$615.60
|
| Rate for Payer: Blue Shield of California Commercial |
$606.37
|
| Rate for Payer: Blue Shield of California EPN |
$481.19
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna of CA HMO |
$656.64
|
| Rate for Payer: Cigna of CA PPO |
$759.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$769.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$615.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$615.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
