|
HC STENT WINGSPAN
|
Facility
|
IP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,758.75 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11,817.24
|
| Rate for Payer: Blue Shield of California EPN |
$7,704.90
|
| Rate for Payer: Cash Price |
$8,408.12
|
| Rate for Payer: Central Health Plan Commercial |
$12,230.00
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,758.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,824.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,462.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,057.50
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: Networks By Design Commercial |
$7,643.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,737.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5,584.52
|
| Rate for Payer: United Healthcare HMO Rider |
$5,463.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,006.66
|
|
|
HC STENT WINGSPAN
|
Facility
|
OP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$13,758.75 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,408.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,465.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,980.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,464.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11,817.24
|
| Rate for Payer: Blue Shield of California EPN |
$7,704.90
|
| Rate for Payer: Cash Price |
$8,408.12
|
| Rate for Payer: Central Health Plan Commercial |
$12,230.00
|
| Rate for Payer: Cigna of CA HMO |
$10,701.25
|
| Rate for Payer: Cigna of CA PPO |
$10,701.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,994.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,994.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,115.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,115.00
|
| Rate for Payer: Galaxy Health WC |
$12,994.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9,172.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,758.75
|
| Rate for Payer: InnovAge PACE Commercial |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,824.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,462.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,057.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,701.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,701.25
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: Networks By Design Commercial |
$7,643.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,994.38
|
| Rate for Payer: Riverside University Health System MISP |
$6,115.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,172.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,172.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,737.40
|
| Rate for Payer: United Healthcare All Other HMO |
$5,584.52
|
| Rate for Payer: United Healthcare HMO Rider |
$5,463.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,006.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.38
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
OP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$374.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$454.57
|
| Rate for Payer: Blue Shield of California Commercial |
$472.91
|
| Rate for Payer: Blue Shield of California EPN |
$308.83
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: InnovAge PACE Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$541.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$541.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Riverside University Health System MISP |
$309.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
|
IP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$445.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.90
|
| Rate for Payer: Blue Shield of California Commercial |
$562.73
|
| Rate for Payer: Blue Shield of California EPN |
$367.48
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: InnovAge PACE Commercial |
$460.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Riverside University Health System MISP |
$368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC STERNOCLAVICLE REDUCTION
|
Facility
|
OP
|
$2,542.00
|
|
|
Service Code
|
CPT 23525
|
| Hospital Charge Code |
902890371
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,042.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,033.60
|
| Rate for Payer: Cigna of CA HMO |
$1,626.88
|
| Rate for Payer: Cigna of CA PPO |
$1,881.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$2,160.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,525.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,287.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,695.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,906.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,652.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,160.70
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,525.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,525.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC STERNOCLAVICLE REDUCTION
|
Facility
|
IP
|
$2,542.00
|
|
|
Service Code
|
CPT 23525
|
| Hospital Charge Code |
902890371
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$508.40 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Adventist Health Commercial |
$508.40
|
| Rate for Payer: Cash Price |
$1,398.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,033.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,016.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,016.80
|
| Rate for Payer: Galaxy Health WC |
$2,160.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,525.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,287.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,695.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$968.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,573.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.40
|
| Rate for Payer: Multiplan Commercial |
$1,906.50
|
| Rate for Payer: Networks By Design Commercial |
$1,652.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,160.70
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$893.70 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Cash Price |
$546.15
|
| Rate for Payer: Central Health Plan Commercial |
$794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.20
|
| Rate for Payer: EPIC Health Plan Senior |
$397.20
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$893.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.60
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
|
|
HC STERNO CLAV JOINTS
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$893.70 |
| Rate for Payer: Adventist Health Commercial |
$198.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$603.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.51
|
| Rate for Payer: Blue Shield of California Commercial |
$602.75
|
| Rate for Payer: Blue Shield of California EPN |
$394.22
|
| Rate for Payer: Cash Price |
$546.15
|
| Rate for Payer: Cash Price |
$546.15
|
| Rate for Payer: Central Health Plan Commercial |
$794.40
|
| Rate for Payer: Cigna of CA HMO |
$635.52
|
| Rate for Payer: Cigna of CA PPO |
$734.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$844.05
|
| Rate for Payer: Global Benefits Group Commercial |
$595.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$893.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$662.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$744.75
|
| Rate for Payer: Networks By Design Commercial |
$645.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$844.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$595.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC STERNUM
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Central Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.20
|
| Rate for Payer: EPIC Health Plan Senior |
$463.20
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.60
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
|
|
HC STERNUM
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
909001427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$1,042.20 |
| Rate for Payer: Adventist Health Commercial |
$231.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$703.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.46
|
| Rate for Payer: Blue Shield of California Commercial |
$702.91
|
| Rate for Payer: Blue Shield of California EPN |
$459.73
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Cash Price |
$636.90
|
| Rate for Payer: Central Health Plan Commercial |
$926.40
|
| Rate for Payer: Cigna of CA HMO |
$741.12
|
| Rate for Payer: Cigna of CA PPO |
$856.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$984.30
|
| Rate for Payer: Global Benefits Group Commercial |
$694.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,042.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$868.50
|
| Rate for Payer: Networks By Design Commercial |
$752.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$984.30
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ST J CATH INQUIRY DECA XL
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Cash Price |
$860.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,407.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.80
|
| Rate for Payer: Multiplan Commercial |
$1,173.00
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
|
|
HC ST J CATH INQUIRY DECA XL
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906812731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$949.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$757.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$918.54
|
| Rate for Payer: Blue Shield of California Commercial |
$955.60
|
| Rate for Payer: Blue Shield of California EPN |
$624.04
|
| Rate for Payer: Cash Price |
$860.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,251.20
|
| Rate for Payer: Cigna of CA HMO |
$1,000.96
|
| Rate for Payer: Cigna of CA PPO |
$1,157.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,329.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,329.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,407.60
|
| Rate for Payer: InnovAge PACE Commercial |
$782.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,043.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$595.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$968.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,094.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$1,173.00
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
| Rate for Payer: Riverside University Health System MISP |
$625.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$938.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$938.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.00
|
| Rate for Payer: United Healthcare All Other HMO |
$782.00
|
| Rate for Payer: United Healthcare HMO Rider |
$782.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,329.40
|
|
|
HC STJ LIVEWIRE CANNULATOR
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906813540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$983.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$784.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$951.43
|
| Rate for Payer: Blue Shield of California Commercial |
$989.82
|
| Rate for Payer: Blue Shield of California EPN |
$646.38
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,036.80
|
| Rate for Payer: Cigna of CA PPO |
$1,198.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: InnovAge PACE Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Riverside University Health System MISP |
$648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC STJ LIVEWIRE CANNULATOR
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1730
|
| Hospital Charge Code |
906813540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$1,053.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
|
|
HC STJ REFLEXION CANN W/LUMEN
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906813539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,008.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,134.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$945.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC STJ REFLEXION CANN W/LUMEN
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT C1731
|
| Hospital Charge Code |
906813539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$765.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,071.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$693.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$945.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$610.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.00
|
| Rate for Payer: Blue Shield of California Commercial |
$769.86
|
| Rate for Payer: Blue Shield of California EPN |
$502.74
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,008.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,071.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,071.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,134.00
|
| Rate for Payer: InnovAge PACE Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$840.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$882.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$882.00
|
| Rate for Payer: Multiplan Commercial |
$945.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Riverside University Health System MISP |
$504.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$630.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$630.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,071.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,071.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,071.00
|
|
|
HC ST J TORQVUE LP DELIVERY SYSTEM
|
Facility
|
IP
|
$3,385.00
|
|
| Hospital Charge Code |
906812705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.00 |
| Max. Negotiated Rate |
$3,046.50 |
| Rate for Payer: Adventist Health Commercial |
$677.00
|
| Rate for Payer: Cash Price |
$1,861.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.00
|
| Rate for Payer: Galaxy Health WC |
$2,877.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,046.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,257.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.00
|
| Rate for Payer: Multiplan Commercial |
$2,538.75
|
| Rate for Payer: Networks By Design Commercial |
$2,200.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,877.25
|
|
|
HC ST J TORQVUE LP DELIVERY SYSTEM
|
Facility
|
OP
|
$3,385.00
|
|
| Hospital Charge Code |
906812705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.00 |
| Max. Negotiated Rate |
$3,046.50 |
| Rate for Payer: Adventist Health Commercial |
$677.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,055.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,877.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,861.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,538.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,639.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,988.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,068.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,350.62
|
| Rate for Payer: Cash Price |
$1,861.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,708.00
|
| Rate for Payer: Cigna of CA HMO |
$2,166.40
|
| Rate for Payer: Cigna of CA PPO |
$2,504.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,877.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,877.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,877.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,354.00
|
| Rate for Payer: Galaxy Health WC |
$2,877.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,031.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,046.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,692.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,257.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,095.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,369.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,369.50
|
| Rate for Payer: Multiplan Commercial |
$2,538.75
|
| Rate for Payer: Networks By Design Commercial |
$2,200.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,877.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,354.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,031.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,031.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,692.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,692.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,692.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,692.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,877.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,877.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,877.25
|
|
|
HC STNT ABBOTT ABSOLUTE PRO
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT ABBOTT ABSOLUTE PRO
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT ABBOTT OMNILINK ELITE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC STNT ABBOTT OMNILINK ELITE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
906812668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,159.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3,014.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT ATRIUM ICAST
|
Facility
|
IP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
906812461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$5,793.75 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Blue Shield of California Commercial |
$4,976.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,244.50
|
| Rate for Payer: Cash Price |
$3,540.63
|
| Rate for Payer: Central Health Plan Commercial |
$5,150.00
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,793.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,293.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,452.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,984.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.50
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
|
