|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
IP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
905356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
OP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
915356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$10,710.00 |
| Rate for Payer: Adventist Health Commercial |
$5,166.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,930.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,297.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9,298.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,123.60
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,710.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,820.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,820.00
|
| Rate for Payer: Multiplan Commercial |
$10,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,560.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,560.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,710.00
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
IP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
915356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASTE MEDIHONEY TUBE .5FL OZ
|
Facility
|
IP
|
$39.69
|
|
|
Service Code
|
CPT A6240
|
| Hospital Charge Code |
901698328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Senior |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.74
|
| Rate for Payer: Global Benefits Group Commercial |
$23.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$31.75
|
| Rate for Payer: Networks By Design Commercial |
$25.80
|
| Rate for Payer: Prime Health Services Commercial |
$33.74
|
|
|
HC PASTE MEDIHONEY TUBE .5FL OZ
|
Facility
|
OP
|
$39.69
|
|
|
Service Code
|
CPT A6240
|
| Hospital Charge Code |
901698328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.37
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cigna of CA HMO |
$25.40
|
| Rate for Payer: Cigna of CA PPO |
$29.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Senior |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.74
|
| Rate for Payer: Global Benefits Group Commercial |
$23.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.78
|
| Rate for Payer: Multiplan Commercial |
$31.75
|
| Rate for Payer: Networks By Design Commercial |
$25.80
|
| Rate for Payer: Prime Health Services Commercial |
$33.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.84
|
| Rate for Payer: United Healthcare All Other HMO |
$19.84
|
| Rate for Payer: United Healthcare HMO Rider |
$19.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.74
|
| Rate for Payer: Vantage Medical Group Senior |
$33.74
|
|
|
HC PATH CONSULT SURG ADDL BLOCK P
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800220
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$82.39 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.39
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC PATH CONSULT SURG ADDL BLOCK P
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800220
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC PATH CONSULT SURGERY FRZN PG
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800219
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC PATH CONSULT SURGERY FRZN PG
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800219
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.27
|
| Rate for Payer: Blue Shield of California Commercial |
$113.73
|
| Rate for Payer: Blue Shield of California EPN |
$75.14
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC PATTEN BOTTOM ADDITION LE
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT L2370
|
| Hospital Charge Code |
905352370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cigna of CA HMO |
$527.80
|
| Rate for Payer: Cigna of CA PPO |
$527.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$301.60
|
| Rate for Payer: Galaxy Health WC |
$640.90
|
| Rate for Payer: Global Benefits Group Commercial |
$452.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$466.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.96
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$640.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.98
|
| Rate for Payer: United Healthcare All Other HMO |
$275.44
|
| Rate for Payer: United Healthcare HMO Rider |
$269.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.94
|
|
|
HC PATTEN BOTTOM ADDITION LE
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT L2370
|
| Hospital Charge Code |
915352370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cigna of CA HMO |
$527.80
|
| Rate for Payer: Cigna of CA PPO |
$527.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$301.60
|
| Rate for Payer: Galaxy Health WC |
$640.90
|
| Rate for Payer: Global Benefits Group Commercial |
$452.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$466.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.96
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$640.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.98
|
| Rate for Payer: United Healthcare All Other HMO |
$275.44
|
| Rate for Payer: United Healthcare HMO Rider |
$269.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.94
|
|
|
HC PATTEN BOTTOM ADDITION LE
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT L2370
|
| Hospital Charge Code |
915352370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Adventist Health Commercial |
$309.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$640.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$414.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$565.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.72
|
| Rate for Payer: Blue Shield of California Commercial |
$556.45
|
| Rate for Payer: Blue Shield of California EPN |
$366.44
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cigna of CA HMO |
$527.80
|
| Rate for Payer: Cigna of CA PPO |
$527.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$640.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$640.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$640.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$301.60
|
| Rate for Payer: Galaxy Health WC |
$640.90
|
| Rate for Payer: Global Benefits Group Commercial |
$452.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$466.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$527.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$527.80
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$640.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$452.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$452.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.98
|
| Rate for Payer: United Healthcare All Other HMO |
$275.44
|
| Rate for Payer: United Healthcare HMO Rider |
$269.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$640.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$640.90
|
| Rate for Payer: Vantage Medical Group Senior |
$640.90
|
|
|
HC PATTEN BOTTOM ADDITION LE
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT L2370
|
| Hospital Charge Code |
905352370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$640.90 |
| Rate for Payer: Adventist Health Commercial |
$309.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$640.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$414.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$565.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.72
|
| Rate for Payer: Blue Shield of California Commercial |
$556.45
|
| Rate for Payer: Blue Shield of California EPN |
$366.44
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cigna of CA HMO |
$527.80
|
| Rate for Payer: Cigna of CA PPO |
$527.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$640.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$640.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$640.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Senior |
$301.60
|
| Rate for Payer: Galaxy Health WC |
$640.90
|
| Rate for Payer: Global Benefits Group Commercial |
$452.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$346.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$466.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$527.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$527.80
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$640.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$452.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$452.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.98
|
| Rate for Payer: United Healthcare All Other HMO |
$275.44
|
| Rate for Payer: United Healthcare HMO Rider |
$269.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$640.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$640.90
|
| Rate for Payer: Vantage Medical Group Senior |
$640.90
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
IP
|
$14,879.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906820243
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,975.80 |
| Max. Negotiated Rate |
$12,647.15 |
| Rate for Payer: Adventist Health Commercial |
$2,975.80
|
| Rate for Payer: Cash Price |
$6,695.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,951.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,951.60
|
| Rate for Payer: Galaxy Health WC |
$12,647.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,927.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,924.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,668.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,210.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,570.96
|
| Rate for Payer: Multiplan Commercial |
$11,903.20
|
| Rate for Payer: Networks By Design Commercial |
$9,671.35
|
| Rate for Payer: Prime Health Services Commercial |
$12,647.15
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
OP
|
$15,309.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906811440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$810.53 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,061.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$6,889.05
|
| Rate for Payer: Cash Price |
$6,889.05
|
| Rate for Payer: Cash Price |
$6,889.05
|
| Rate for Payer: Cigna of CA HMO |
$9,950.85
|
| Rate for Payer: Cigna of CA PPO |
$11,328.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$13,012.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,185.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$810.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,211.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,674.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$12,247.20
|
| Rate for Payer: Networks By Design Commercial |
$9,950.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,012.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,185.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,185.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
IP
|
$15,309.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906811440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,061.80 |
| Max. Negotiated Rate |
$13,012.65 |
| Rate for Payer: Adventist Health Commercial |
$3,061.80
|
| Rate for Payer: Cash Price |
$6,889.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,123.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,123.60
|
| Rate for Payer: Galaxy Health WC |
$13,012.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,185.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,211.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,832.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,476.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,674.16
|
| Rate for Payer: Multiplan Commercial |
$12,247.20
|
| Rate for Payer: Networks By Design Commercial |
$9,950.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,012.65
|
|
|
HC PCI BYPASS GRAFT
|
Facility
|
OP
|
$14,879.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906820243
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$810.53 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,975.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$6,695.55
|
| Rate for Payer: Cash Price |
$6,695.55
|
| Rate for Payer: Cash Price |
$6,695.55
|
| Rate for Payer: Cigna of CA HMO |
$9,671.35
|
| Rate for Payer: Cigna of CA PPO |
$11,010.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$12,647.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,927.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$810.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,924.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,570.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$11,903.20
|
| Rate for Payer: Networks By Design Commercial |
$9,671.35
|
| Rate for Payer: Prime Health Services Commercial |
$12,647.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,927.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,927.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
|
OP
|
$26,699.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906820262
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$22,694.15 |
| Rate for Payer: Adventist Health Commercial |
$5,339.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17,511.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,684.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,024.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$12,014.55
|
| Rate for Payer: Cash Price |
$12,014.55
|
| Rate for Payer: Cigna of CA HMO |
$17,087.36
|
| Rate for Payer: Cigna of CA PPO |
$19,757.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,694.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,694.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,679.60
|
| Rate for Payer: Galaxy Health WC |
$22,694.15
|
| Rate for Payer: Global Benefits Group Commercial |
$16,019.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,808.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,172.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,526.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,407.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,689.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,689.30
|
| Rate for Payer: Multiplan Commercial |
$21,359.20
|
| Rate for Payer: Networks By Design Commercial |
$17,354.35
|
| Rate for Payer: Prime Health Services Commercial |
$22,694.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,019.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,019.40
|
| 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 |
$22,694.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,694.15
|
| Rate for Payer: Vantage Medical Group Senior |
$22,694.15
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
|
IP
|
$26,699.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906820262
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,339.80 |
| Max. Negotiated Rate |
$22,694.15 |
| Rate for Payer: Adventist Health Commercial |
$5,339.80
|
| Rate for Payer: Cash Price |
$12,014.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,679.60
|
| Rate for Payer: Galaxy Health WC |
$22,694.15
|
| Rate for Payer: Global Benefits Group Commercial |
$16,019.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,808.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,172.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,526.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,407.76
|
| Rate for Payer: Multiplan Commercial |
$21,359.20
|
| Rate for Payer: Networks By Design Commercial |
$17,354.35
|
| Rate for Payer: Prime Health Services Commercial |
$22,694.15
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
|
IP
|
$27,471.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906811464
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,494.20 |
| Max. Negotiated Rate |
$23,350.35 |
| Rate for Payer: Adventist Health Commercial |
$5,494.20
|
| Rate for Payer: Cash Price |
$12,361.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,988.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,988.40
|
| Rate for Payer: Galaxy Health WC |
$23,350.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,482.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,323.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,466.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,004.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,593.04
|
| Rate for Payer: Multiplan Commercial |
$21,976.80
|
| Rate for Payer: Networks By Design Commercial |
$17,856.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,350.35
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
|
OP
|
$27,471.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906811464
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$23,350.35 |
| Rate for Payer: Adventist Health Commercial |
$5,494.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18,018.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,350.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,109.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,603.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$12,361.95
|
| Rate for Payer: Cash Price |
$12,361.95
|
| Rate for Payer: Cigna of CA HMO |
$17,581.44
|
| Rate for Payer: Cigna of CA PPO |
$20,328.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,350.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,350.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,350.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,988.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,988.40
|
| Rate for Payer: Galaxy Health WC |
$23,350.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,482.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,323.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,466.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,004.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,593.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,229.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,229.70
|
| Rate for Payer: Multiplan Commercial |
$21,976.80
|
| Rate for Payer: Networks By Design Commercial |
$17,856.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,350.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,482.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,482.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,350.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,350.35
|
| Rate for Payer: Vantage Medical Group Senior |
$23,350.35
|
|
