|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,211.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,652.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cigna of CA HMO |
$1,409.92
|
| Rate for Payer: Cigna of CA PPO |
$1,630.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,872.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,542.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,398.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,299.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,542.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,542.10
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,321.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,101.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,872.55
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| 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 |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,539.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| 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/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$335.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,303.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$379.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| 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 |
$1,814.00
|
| 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 |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,539.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,303.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,140.52
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,539.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,303.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,140.52
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| 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 |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,539.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| 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/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,303.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| 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 |
$1,814.00
|
| 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 |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| 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 |
$2,016.95
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| 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 |
$2,016.95
|
| 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
|
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 |
$1,878.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,386.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,573.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,119.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| 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 |
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 |
$1,878.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,386.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,573.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,119.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,970.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,830.77
|
| 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, 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$587.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| 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 |
$1,909.70
|
| 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 |
$1,778.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,259.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,469.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,661.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$587.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| 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 |
$1,909.70
|
| 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 |
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 |
$1,778.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,259.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,469.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,661.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.42
|
| 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
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
903800239
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.14
|
| 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 |
$326.60
|
| Rate for Payer: Blue Shield of California Commercial |
$155.82
|
| Rate for Payer: Blue Shield of California Commercial |
$235.59
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.05
|
| Rate for Payer: EPIC Health Plan Senior |
$150.70
|
| Rate for Payer: Galaxy Health WC |
$287.30
|
| Rate for Payer: Global Benefits Group Commercial |
$202.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$214.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.80
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$214.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.42
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| 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 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: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.82
|
| 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 |
$65.04
|
| Rate for Payer: Blue Shield of California Commercial |
$53.94
|
| Rate for Payer: Blue Shield of California Commercial |
$81.55
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3.29
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.19
|
| 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
|
|
|
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 |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| 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/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,876.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,057.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,121.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,690.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| 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 |
$11,856.00
|
| 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 |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,598.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15,057.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,990.08
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,936.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$14,456.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,431.94
|
| 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
|
$22,766.00
|
|
|
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 |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,936.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| 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/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,654.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,456.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,871.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,463.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| 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 |
$11,383.00
|
| 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 |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
IP
|
$24,631.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,926.20 |
| Max. Negotiated Rate |
$20,936.35 |
| Rate for Payer: Adventist Health Commercial |
$4,926.20
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,241.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,852.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,852.40
|
| Rate for Payer: Galaxy Health WC |
$20,936.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,778.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,640.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,532.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,911.44
|
| Rate for Payer: Multiplan Commercial |
$19,704.80
|
| Rate for Payer: Networks By Design Commercial |
$16,010.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,936.35
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
OP
|
$24,631.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$4,926.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: Cash Price |
$11,083.95
|
| Rate for Payer: Cigna of CA HMO |
$16,010.15
|
| Rate for Payer: Cigna of CA PPO |
$18,226.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,241.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$20,936.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,778.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,882.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,640.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,128.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,911.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$19,704.80
|
| Rate for Payer: Networks By Design Commercial |
$16,010.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,936.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,778.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,315.50
|
| 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 |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$17,208.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,441.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cigna of CA HMO |
$11,185.20
|
| Rate for Payer: Cigna of CA PPO |
$12,733.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,045.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$14,626.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,324.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,159.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,927.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,442.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,129.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$13,766.40
|
| Rate for Payer: Networks By Design Commercial |
$11,185.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,324.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,604.00
|
| 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 |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$17,208.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,441.60 |
| Max. Negotiated Rate |
$14,626.80 |
| Rate for Payer: Adventist Health Commercial |
$3,441.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,045.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,883.20
|
| Rate for Payer: Galaxy Health WC |
$14,626.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,324.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,927.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,152.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,129.92
|
| Rate for Payer: Multiplan Commercial |
$13,766.40
|
| Rate for Payer: Networks By Design Commercial |
$11,185.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,626.80
|
|
