|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
IP
|
$7,654.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906811441
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,530.80 |
| Max. Negotiated Rate |
$6,505.90 |
| Rate for Payer: Adventist Health Commercial |
$1,530.80
|
| Rate for Payer: Cash Price |
$3,444.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,061.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,061.60
|
| Rate for Payer: Galaxy Health WC |
$6,505.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,592.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,916.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,737.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.96
|
| Rate for Payer: Multiplan Commercial |
$6,123.20
|
| Rate for Payer: Networks By Design Commercial |
$4,975.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,505.90
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
OP
|
$7,439.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906820244
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,487.80 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,487.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,323.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,091.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,579.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$3,347.55
|
| Rate for Payer: Cash Price |
$3,347.55
|
| Rate for Payer: Cigna of CA HMO |
$4,835.35
|
| Rate for Payer: Cigna of CA PPO |
$5,504.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,323.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,323.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,323.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,975.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,975.60
|
| Rate for Payer: Galaxy Health WC |
$6,323.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,463.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,961.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,604.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,207.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,207.30
|
| Rate for Payer: Multiplan Commercial |
$5,951.20
|
| Rate for Payer: Networks By Design Commercial |
$4,835.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,323.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,463.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,463.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$6,323.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,323.15
|
| Rate for Payer: Vantage Medical Group Senior |
$6,323.15
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
IP
|
$7,439.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906820244
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,487.80 |
| Max. Negotiated Rate |
$6,323.15 |
| Rate for Payer: Adventist Health Commercial |
$1,487.80
|
| Rate for Payer: Cash Price |
$3,347.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,975.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,975.60
|
| Rate for Payer: Galaxy Health WC |
$6,323.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,463.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,961.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,834.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,604.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.36
|
| Rate for Payer: Multiplan Commercial |
$5,951.20
|
| Rate for Payer: Networks By Design Commercial |
$4,835.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,323.15
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
OP
|
$7,654.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906811441
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,530.80 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,530.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,505.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,209.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,740.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$3,444.30
|
| Rate for Payer: Cash Price |
$3,444.30
|
| Rate for Payer: Cigna of CA HMO |
$4,975.10
|
| Rate for Payer: Cigna of CA PPO |
$5,663.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,505.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,505.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,505.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,061.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,061.60
|
| Rate for Payer: Galaxy Health WC |
$6,505.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,592.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,737.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,357.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,357.80
|
| Rate for Payer: Multiplan Commercial |
$6,123.20
|
| Rate for Payer: Networks By Design Commercial |
$4,975.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,505.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,592.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,592.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$6,505.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,505.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,505.90
|
|
|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
IP
|
$17,855.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906820246
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,571.00 |
| Max. Negotiated Rate |
$15,176.75 |
| Rate for Payer: Adventist Health Commercial |
$3,571.00
|
| Rate for Payer: Cash Price |
$8,034.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,142.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,142.00
|
| Rate for Payer: Galaxy Health WC |
$15,176.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,713.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,909.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,802.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,052.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,285.20
|
| Rate for Payer: Multiplan Commercial |
$14,284.00
|
| Rate for Payer: Networks By Design Commercial |
$11,605.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,176.75
|
|
|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
IP
|
$18,372.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906811443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,674.40 |
| Max. Negotiated Rate |
$15,616.20 |
| Rate for Payer: Adventist Health Commercial |
$3,674.40
|
| Rate for Payer: Cash Price |
$8,267.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,348.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,348.80
|
| Rate for Payer: Galaxy Health WC |
$15,616.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,023.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,254.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,999.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,372.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,409.28
|
| Rate for Payer: Multiplan Commercial |
$14,697.60
|
| Rate for Payer: Networks By Design Commercial |
$11,941.80
|
| Rate for Payer: Prime Health Services Commercial |
$15,616.20
|
|
|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
OP
|
$18,372.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906811443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$909.18 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,674.40
|
| 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 |
$8,267.40
|
| Rate for Payer: Cash Price |
$8,267.40
|
| Rate for Payer: Cash Price |
$8,267.40
|
| Rate for Payer: Cigna of CA HMO |
$11,941.80
|
| Rate for Payer: Cigna of CA PPO |
$13,595.28
|
| 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 |
$15,616.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,023.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$909.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,254.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,409.28
|
| 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 |
$14,697.60
|
| Rate for Payer: Networks By Design Commercial |
$11,941.80
|
| Rate for Payer: Prime Health Services Commercial |
$15,616.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,023.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,023.20
|
| 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 CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
OP
|
$17,855.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906820246
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$909.18 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,571.00
|
| 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 |
$8,034.75
|
| Rate for Payer: Cash Price |
$8,034.75
|
| Rate for Payer: Cash Price |
$8,034.75
|
| Rate for Payer: Cigna of CA HMO |
$11,605.75
|
| Rate for Payer: Cigna of CA PPO |
$13,212.70
|
| 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 |
$15,176.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,713.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$909.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,909.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,285.20
|
| 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 |
$14,284.00
|
| Rate for Payer: Networks By Design Commercial |
$11,605.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,176.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,713.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,713.00
|
| 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 CORO BYPASS CHRONIC 1 VSL
|
Facility
|
OP
|
$36,885.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$16,598.25
|
| Rate for Payer: Cash Price |
$16,598.25
|
| Rate for Payer: Cash Price |
$16,598.25
|
| Rate for Payer: Cigna of CA HMO |
$23,606.40
|
| Rate for Payer: Cigna of CA PPO |
$27,294.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$29,508.00
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,131.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,131.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
IP
|
$36,885.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,377.00 |
| Max. Negotiated Rate |
$31,352.25 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Cash Price |
$16,598.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,754.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,754.00
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,831.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.40
|
| Rate for Payer: Multiplan Commercial |
$29,508.00
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
OP
|
$37,952.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$7,590.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$17,078.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Cigna of CA HMO |
$24,289.28
|
| Rate for Payer: Cigna of CA PPO |
$28,084.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$32,259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,771.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,313.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,459.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$30,361.60
|
| Rate for Payer: Networks By Design Commercial |
$24,668.80
|
| Rate for Payer: Prime Health Services Commercial |
$32,259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,771.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,771.20
|
| 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: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
IP
|
$37,952.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,590.40 |
| Max. Negotiated Rate |
$32,259.20 |
| Rate for Payer: Adventist Health Commercial |
$7,590.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$15,180.80
|
| Rate for Payer: Galaxy Health WC |
$32,259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,771.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,313.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,459.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,492.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,108.48
|
| Rate for Payer: Multiplan Commercial |
$30,361.60
|
| Rate for Payer: Networks By Design Commercial |
$24,668.80
|
| Rate for Payer: Prime Health Services Commercial |
$32,259.20
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
OP
|
$35,128.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$29,858.80 |
| Rate for Payer: Adventist Health Commercial |
$7,025.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23,040.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,320.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26,346.00
|
| 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 |
$15,807.60
|
| Rate for Payer: Cash Price |
$15,807.60
|
| Rate for Payer: Cigna of CA HMO |
$22,481.92
|
| Rate for Payer: Cigna of CA PPO |
$25,994.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,858.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29,858.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,051.20
|
| Rate for Payer: Galaxy Health WC |
$29,858.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21,076.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,430.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,383.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,744.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,430.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,589.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,589.60
|
| Rate for Payer: Multiplan Commercial |
$28,102.40
|
| Rate for Payer: Networks By Design Commercial |
$22,833.20
|
| Rate for Payer: Prime Health Services Commercial |
$29,858.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,076.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,076.80
|
| 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 |
$29,858.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,858.80
|
| Rate for Payer: Vantage Medical Group Senior |
$29,858.80
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$35,128.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,025.60 |
| Max. Negotiated Rate |
$29,858.80 |
| Rate for Payer: Adventist Health Commercial |
$7,025.60
|
| Rate for Payer: Cash Price |
$15,807.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,051.20
|
| Rate for Payer: Galaxy Health WC |
$29,858.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21,076.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,430.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,383.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,744.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,430.72
|
| Rate for Payer: Multiplan Commercial |
$28,102.40
|
| Rate for Payer: Networks By Design Commercial |
$22,833.20
|
| Rate for Payer: Prime Health Services Commercial |
$29,858.80
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
OP
|
$36,145.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$30,723.25 |
| Rate for Payer: Adventist Health Commercial |
$7,229.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23,707.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,723.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,879.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,108.75
|
| 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 |
$16,265.25
|
| Rate for Payer: Cash Price |
$16,265.25
|
| Rate for Payer: Cigna of CA HMO |
$23,132.80
|
| Rate for Payer: Cigna of CA PPO |
$26,747.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,723.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,723.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,723.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,458.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,458.00
|
| Rate for Payer: Galaxy Health WC |
$30,723.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21,687.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,108.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,771.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,674.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,301.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,301.50
|
| Rate for Payer: Multiplan Commercial |
$28,916.00
|
| Rate for Payer: Networks By Design Commercial |
$23,494.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,723.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,687.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,687.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,723.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,723.25
|
| Rate for Payer: Vantage Medical Group Senior |
$30,723.25
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$36,145.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,229.00 |
| Max. Negotiated Rate |
$30,723.25 |
| Rate for Payer: Adventist Health Commercial |
$7,229.00
|
| Rate for Payer: Cash Price |
$16,265.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,458.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,458.00
|
| Rate for Payer: Galaxy Health WC |
$30,723.25
|
| Rate for Payer: Global Benefits Group Commercial |
$21,687.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,108.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,771.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,373.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,674.80
|
| Rate for Payer: Multiplan Commercial |
$28,916.00
|
| Rate for Payer: Networks By Design Commercial |
$23,494.25
|
| Rate for Payer: Prime Health Services Commercial |
$30,723.25
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$9,185.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,837.00 |
| Max. Negotiated Rate |
$7,807.25 |
| Rate for Payer: Adventist Health Commercial |
$1,837.00
|
| Rate for Payer: Cash Price |
$4,133.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,674.00
|
| Rate for Payer: Galaxy Health WC |
$7,807.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,511.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,126.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,499.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,685.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,204.40
|
| Rate for Payer: Multiplan Commercial |
$7,348.00
|
| Rate for Payer: Networks By Design Commercial |
$5,970.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,807.25
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,785.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,909.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,695.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$4,017.15
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: Cigna of CA HMO |
$5,802.55
|
| Rate for Payer: Cigna of CA PPO |
$6,605.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,587.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,954.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,525.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,142.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,248.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,248.90
|
| Rate for Payer: Multiplan Commercial |
$7,141.60
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,356.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,356.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,587.95
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,785.40 |
| Max. Negotiated Rate |
$7,587.95 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Cash Price |
$4,017.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,954.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,401.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,525.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,142.48
|
| Rate for Payer: Multiplan Commercial |
$7,141.60
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$9,185.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,837.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,837.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,807.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,051.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,888.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| 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 |
$4,133.25
|
| Rate for Payer: Cash Price |
$4,133.25
|
| Rate for Payer: Cigna of CA HMO |
$5,970.25
|
| Rate for Payer: Cigna of CA PPO |
$6,796.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,807.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,807.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,807.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,674.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,674.00
|
| Rate for Payer: Galaxy Health WC |
$7,807.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,511.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,126.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,685.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,204.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,429.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,429.50
|
| Rate for Payer: Multiplan Commercial |
$7,348.00
|
| Rate for Payer: Networks By Design Commercial |
$5,970.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,807.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,511.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,511.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$7,807.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,807.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,807.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$36,885.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,377.00 |
| Max. Negotiated Rate |
$31,352.25 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Cash Price |
$16,598.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,754.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,754.00
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,831.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.40
|
| Rate for Payer: Multiplan Commercial |
$29,508.00
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$36,885.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$31,352.25 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,192.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,352.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,286.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,663.75
|
| 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 |
$16,598.25
|
| Rate for Payer: Cash Price |
$16,598.25
|
| Rate for Payer: Cigna of CA HMO |
$23,606.40
|
| Rate for Payer: Cigna of CA PPO |
$27,294.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,352.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,352.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,352.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,754.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,754.00
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,831.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,819.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,819.50
|
| Rate for Payer: Multiplan Commercial |
$29,508.00
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,131.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,131.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,352.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,352.25
|
| Rate for Payer: Vantage Medical Group Senior |
$31,352.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$37,952.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$32,259.20 |
| Rate for Payer: Adventist Health Commercial |
$7,590.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,892.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,259.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,873.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,464.00
|
| 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 |
$17,078.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: Cigna of CA HMO |
$24,289.28
|
| Rate for Payer: Cigna of CA PPO |
$28,084.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,259.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,259.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,259.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$15,180.80
|
| Rate for Payer: Galaxy Health WC |
$32,259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,771.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,313.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,459.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,492.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,566.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,566.40
|
| Rate for Payer: Multiplan Commercial |
$30,361.60
|
| Rate for Payer: Networks By Design Commercial |
$24,668.80
|
| Rate for Payer: Prime Health Services Commercial |
$32,259.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,771.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,771.20
|
| 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 |
$32,259.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,259.20
|
| Rate for Payer: Vantage Medical Group Senior |
$32,259.20
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$37,952.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,590.40 |
| Max. Negotiated Rate |
$32,259.20 |
| Rate for Payer: Adventist Health Commercial |
$7,590.40
|
| Rate for Payer: Cash Price |
$17,078.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$15,180.80
|
| Rate for Payer: Galaxy Health WC |
$32,259.20
|
| Rate for Payer: Global Benefits Group Commercial |
$22,771.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,313.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,459.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,492.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,108.48
|
| Rate for Payer: Multiplan Commercial |
$30,361.60
|
| Rate for Payer: Networks By Design Commercial |
$24,668.80
|
| Rate for Payer: Prime Health Services Commercial |
$32,259.20
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$22,965.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,593.00 |
| Max. Negotiated Rate |
$19,520.25 |
| Rate for Payer: Adventist Health Commercial |
$4,593.00
|
| Rate for Payer: Cash Price |
$10,334.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,186.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,186.00
|
| Rate for Payer: Galaxy Health WC |
$19,520.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,317.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,749.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,215.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,511.60
|
| Rate for Payer: Multiplan Commercial |
$18,372.00
|
| Rate for Payer: Networks By Design Commercial |
$14,927.25
|
| Rate for Payer: Prime Health Services Commercial |
$19,520.25
|
|
