|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$3,083.80 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,451.20
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,382.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.24 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| 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 |
$2,822.94
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cigna of CA HMO |
$2,321.92
|
| Rate for Payer: Cigna of CA PPO |
$2,684.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$335.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$3,083.80 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,451.20
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,382.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.37 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| 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 |
$2,822.94
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cigna of CA HMO |
$2,321.92
|
| Rate for Payer: Cigna of CA PPO |
$2,684.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
905352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$744.72 |
| Max. Negotiated Rate |
$2,637.55 |
| Rate for Payer: Adventist Health Commercial |
$1,272.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,706.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,327.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,797.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,290.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.06
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,637.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,637.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,119.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,172.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,172.10
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,861.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,861.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,637.55
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
915352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$744.72 |
| Max. Negotiated Rate |
$2,637.55 |
| Rate for Payer: Adventist Health Commercial |
$1,272.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,706.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,327.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,797.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,290.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.06
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,637.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,637.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,119.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,172.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,172.10
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,861.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,861.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,637.55
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
905352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,182.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
915352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cash Price |
$1,396.35
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,182.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
915352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$705.12 |
| Max. Negotiated Rate |
$2,497.30 |
| Rate for Payer: Adventist Health Commercial |
$1,204.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,701.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,168.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.87
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,497.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,497.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,469.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,661.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.60
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,497.30
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
915352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$587.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
905352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$587.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
905352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$705.12 |
| Max. Negotiated Rate |
$2,497.30 |
| Rate for Payer: Adventist Health Commercial |
$1,204.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,701.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,168.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.87
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,497.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,497.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,469.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,661.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.60
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,497.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,497.30
|
|
|
HC RHABDOMYOSARCOMABY RT-PCR
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
903800239
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$135.20
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
|
|
HC RHABDOMYOSARCOMABY RT-PCR
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
903800239
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$312.54 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.54
|
| Rate for Payer: Blue Shield of California Commercial |
$226.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.40
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna of CA HMO |
$216.32
|
| Rate for Payer: Cigna of CA PPO |
$250.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: EPIC Health Plan Senior |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: Networks By Design Commercial |
$219.70
|
| Rate for Payer: Prime Health Services Commercial |
$287.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC RH BLOOD GROUP
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$78.27
|
| Rate for Payer: Blue Shield of California EPN |
$51.71
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO |
$74.88
|
| Rate for Payer: Cigna of CA PPO |
$86.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC RH BLOOD GROUP
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
IP
|
$23,712.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,742.40 |
| Max. Negotiated Rate |
$20,155.20 |
| Rate for Payer: Adventist Health Commercial |
$4,742.40
|
| Rate for Payer: Cash Price |
$10,670.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,484.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,484.80
|
| Rate for Payer: Galaxy Health WC |
$20,155.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14,227.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,815.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,034.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,677.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,690.88
|
| Rate for Payer: Multiplan Commercial |
$18,969.60
|
| Rate for Payer: Networks By Design Commercial |
$15,412.80
|
| Rate for Payer: Prime Health Services Commercial |
$20,155.20
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
IP
|
$23,045.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906820062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,609.00 |
| Max. Negotiated Rate |
$19,588.25 |
| Rate for Payer: Adventist Health Commercial |
$4,609.00
|
| Rate for Payer: Cash Price |
$10,370.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,218.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,218.00
|
| Rate for Payer: Galaxy Health WC |
$19,588.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,827.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,371.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,780.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,264.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,530.80
|
| Rate for Payer: Multiplan Commercial |
$18,436.00
|
| Rate for Payer: Networks By Design Commercial |
$14,979.25
|
| Rate for Payer: Prime Health Services Commercial |
$19,588.25
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
OP
|
$23,712.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,742.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$5,510.17
|
| Rate for Payer: Cash Price |
$10,670.40
|
| Rate for Payer: Cash Price |
$10,670.40
|
| Rate for Payer: Cash Price |
$10,670.40
|
| Rate for Payer: Cigna of CA HMO |
$15,412.80
|
| Rate for Payer: Cigna of CA PPO |
$17,546.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$20,155.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14,227.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,876.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,815.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,121.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,690.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$18,969.60
|
| Rate for Payer: Networks By Design Commercial |
$15,412.80
|
| Rate for Payer: Prime Health Services Commercial |
$20,155.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,227.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
OP
|
$23,045.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906820062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,609.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$5,510.17
|
| Rate for Payer: Cash Price |
$10,370.25
|
| Rate for Payer: Cash Price |
$10,370.25
|
| Rate for Payer: Cash Price |
$10,370.25
|
| Rate for Payer: Cigna of CA HMO |
$14,979.25
|
| Rate for Payer: Cigna of CA PPO |
$17,053.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$19,588.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,827.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,876.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,371.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,121.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,530.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$18,436.00
|
| Rate for Payer: Networks By Design Commercial |
$14,979.25
|
| Rate for Payer: Prime Health Services Commercial |
$19,588.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,827.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$22,766.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,553.20 |
| Max. Negotiated Rate |
$19,351.10 |
| Rate for Payer: Adventist Health Commercial |
$4,553.20
|
| Rate for Payer: Cash Price |
$10,244.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,106.40
|
| Rate for Payer: Galaxy Health WC |
$19,351.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,659.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,184.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,673.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,092.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,463.84
|
| Rate for Payer: Multiplan Commercial |
$18,212.80
|
| Rate for Payer: Networks By Design Commercial |
$14,797.90
|
| Rate for Payer: Prime Health Services Commercial |
$19,351.10
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$22,126.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906820061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,654.82 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,425.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$5,510.17
|
| Rate for Payer: Cash Price |
$9,956.70
|
| Rate for Payer: Cash Price |
$9,956.70
|
| Rate for Payer: Cash Price |
$9,956.70
|
| Rate for Payer: Cigna of CA HMO |
$14,381.90
|
| Rate for Payer: Cigna of CA PPO |
$16,373.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$18,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,275.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,654.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,758.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,310.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$17,700.80
|
| Rate for Payer: Networks By Design Commercial |
$14,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,807.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$22,126.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906820061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,425.20 |
| Max. Negotiated Rate |
$18,807.10 |
| Rate for Payer: Adventist Health Commercial |
$4,425.20
|
| Rate for Payer: Cash Price |
$9,956.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,850.40
|
| Rate for Payer: Galaxy Health WC |
$18,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,275.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,758.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,430.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,695.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,310.24
|
| Rate for Payer: Multiplan Commercial |
$17,700.80
|
| Rate for Payer: Networks By Design Commercial |
$14,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,807.10
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$22,766.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,654.82 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,553.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$5,510.17
|
| Rate for Payer: Cash Price |
$10,244.70
|
| Rate for Payer: Cash Price |
$10,244.70
|
| Rate for Payer: Cash Price |
$10,244.70
|
| Rate for Payer: Cigna of CA HMO |
$14,797.90
|
| Rate for Payer: Cigna of CA PPO |
$16,846.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$19,351.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,659.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,654.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,184.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,463.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$18,212.80
|
| Rate for Payer: Networks By Design Commercial |
$14,797.90
|
| Rate for Payer: Prime Health Services Commercial |
$19,351.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,659.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
IP
|
$23,939.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906820065
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,787.80 |
| Max. Negotiated Rate |
$20,348.15 |
| Rate for Payer: Adventist Health Commercial |
$4,787.80
|
| Rate for Payer: Cash Price |
$10,772.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,575.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,575.60
|
| Rate for Payer: Galaxy Health WC |
$20,348.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14,363.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,967.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,120.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,818.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.36
|
| Rate for Payer: Multiplan Commercial |
$19,151.20
|
| Rate for Payer: Networks By Design Commercial |
$15,560.35
|
| Rate for Payer: Prime Health Services Commercial |
$20,348.15
|
|
