|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO |
$1,123.20
|
| Rate for Payer: Cigna of CA PPO |
$1,298.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,170.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,404.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,491.75
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO |
$877.50
|
| Rate for Payer: United Healthcare HMO Rider |
$877.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,491.75 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$702.00
|
| Rate for Payer: Galaxy Health WC |
$1,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,170.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$668.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,086.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$1,404.00
|
| Rate for Payer: Networks By Design Commercial |
$1,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,491.75
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
IP
|
$2,962.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$592.40 |
| Max. Negotiated Rate |
$2,517.70 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.80
|
| Rate for Payer: Galaxy Health WC |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,975.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,128.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,833.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Multiplan Commercial |
$2,369.60
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
OP
|
$2,962.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.24 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cigna of CA HMO |
$1,895.68
|
| Rate for Payer: Cigna of CA PPO |
$2,191.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,975.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,369.60
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,777.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,481.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,481.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,481.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,481.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
IP
|
$2,241.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.20 |
| Max. Negotiated Rate |
$1,904.85 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.40
|
| Rate for Payer: EPIC Health Plan Senior |
$896.40
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,387.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Multiplan Commercial |
$1,792.80
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
|
|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
OP
|
$2,241.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Cigna of CA HMO |
$1,434.24
|
| Rate for Payer: Cigna of CA PPO |
$1,658.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$798.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$1,792.80
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,344.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$321.92
|
| Rate for Payer: Cigna of CA PPO |
$372.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.50
|
| Rate for Payer: United Healthcare All Other HMO |
$251.50
|
| Rate for Payer: United Healthcare HMO Rider |
$251.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$321.92
|
| Rate for Payer: Cigna of CA PPO |
$372.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,959.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,770.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| 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 |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906811575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| 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 |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| 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 |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906811573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,959.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,770.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| 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 |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,959.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,770.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO |
$2,887.68
|
| Rate for Payer: Cigna of CA PPO |
$3,338.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,707.20
|
| 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 |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| 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 |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906811569
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,045.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,553.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,482.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,851.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: Cigna of CA HMO |
$2,971.52
|
| Rate for Payer: Cigna of CA PPO |
$3,435.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,946.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,946.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,946.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,250.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,250.10
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,785.80
|
| 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 |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,946.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906811574
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$3,946.55 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Cash Price |
$2,089.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.32
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Networks By Design Commercial |
$3,017.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$902.40 |
| Max. Negotiated Rate |
$3,835.20 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,804.80
|
| Rate for Payer: Galaxy Health WC |
$3,835.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,009.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,792.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.88
|
| Rate for Payer: Multiplan Commercial |
$3,609.60
|
| Rate for Payer: Networks By Design Commercial |
$2,932.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,835.20
|
|
