|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| 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 |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC VAD DRSNG CHANGE KIT W/PVP
|
Facility
|
IP
|
$220.85
|
|
| Hospital Charge Code |
901698893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$198.76 |
| Rate for Payer: Adventist Health Commercial |
$44.17
|
| Rate for Payer: Cash Price |
$121.47
|
| Rate for Payer: Central Health Plan Commercial |
$176.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: EPIC Health Plan Senior |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.17
|
| Rate for Payer: Multiplan Commercial |
$165.64
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
|
|
HC VAD DRSNG CHANGE KIT W/PVP
|
Facility
|
OP
|
$220.85
|
|
| Hospital Charge Code |
901698893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$198.76 |
| Rate for Payer: Adventist Health Commercial |
$44.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.71
|
| Rate for Payer: Blue Shield of California Commercial |
$134.94
|
| Rate for Payer: Blue Shield of California EPN |
$88.12
|
| Rate for Payer: Cash Price |
$121.47
|
| Rate for Payer: Central Health Plan Commercial |
$176.68
|
| Rate for Payer: Cigna of CA HMO |
$141.34
|
| Rate for Payer: Cigna of CA PPO |
$163.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: EPIC Health Plan Senior |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.76
|
| Rate for Payer: InnovAge PACE Commercial |
$110.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.59
|
| Rate for Payer: Multiplan Commercial |
$165.64
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
| Rate for Payer: Riverside University Health System MISP |
$88.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.42
|
| Rate for Payer: United Healthcare All Other HMO |
$110.42
|
| Rate for Payer: United Healthcare HMO Rider |
$110.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.72
|
| Rate for Payer: Vantage Medical Group Senior |
$187.72
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
OP
|
$9,264.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$11,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,852.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,626.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,874.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,095.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,948.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,407.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,660.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,696.34
|
| Rate for Payer: Cash Price |
$5,095.20
|
| Rate for Payer: Cash Price |
$5,095.20
|
| Rate for Payer: Cash Price |
$5,095.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,411.20
|
| Rate for Payer: Cigna of CA HMO |
$5,928.96
|
| Rate for Payer: Cigna of CA PPO |
$6,855.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,874.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,874.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,874.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,705.60
|
| Rate for Payer: Galaxy Health WC |
$7,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,337.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,596.88
|
| Rate for Payer: InnovAge PACE Commercial |
$4,632.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,179.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,973.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,734.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,852.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,484.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,484.80
|
| Rate for Payer: Multiplan Commercial |
$6,948.00
|
| Rate for Payer: Networks By Design Commercial |
$6,021.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,874.40
|
| Rate for Payer: Riverside University Health System MISP |
$3,705.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,558.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,558.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,874.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,874.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,874.40
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
IP
|
$9,264.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,852.80 |
| Max. Negotiated Rate |
$8,337.60 |
| Rate for Payer: Adventist Health Commercial |
$1,852.80
|
| Rate for Payer: Cash Price |
$5,095.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,705.60
|
| Rate for Payer: Galaxy Health WC |
$7,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,337.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,179.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,734.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,852.80
|
| Rate for Payer: Multiplan Commercial |
$6,948.00
|
| Rate for Payer: Networks By Design Commercial |
$6,021.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,874.40
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$7,016.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,403.20 |
| Max. Negotiated Rate |
$6,314.40 |
| Rate for Payer: Adventist Health Commercial |
$1,403.20
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,806.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,806.40
|
| Rate for Payer: Galaxy Health WC |
$5,963.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,209.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,314.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,673.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,342.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.20
|
| Rate for Payer: Multiplan Commercial |
$5,262.00
|
| Rate for Payer: Networks By Design Commercial |
$4,560.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,963.60
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$7,016.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,403.20
|
| 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 |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,407.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,240.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,612.80
|
| Rate for Payer: Cigna of CA HMO |
$4,490.24
|
| Rate for Payer: Cigna of CA PPO |
$5,191.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$5,963.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,209.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,314.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,034.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$5,262.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,560.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$5,963.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,209.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,508.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,508.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,508.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,508.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC VAGINAL REPAIR
|
Facility
|
OP
|
$9,569.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
902400755
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$358.07 |
| Max. Negotiated Rate |
$8,612.10 |
| Rate for Payer: Adventist Health Commercial |
$1,913.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,039.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,846.66
|
| Rate for Payer: Blue Shield of California EPN |
$3,818.03
|
| Rate for Payer: Cash Price |
$5,262.95
|
| Rate for Payer: Cash Price |
$5,262.95
|
| Rate for Payer: Cash Price |
$5,262.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,655.20
|
| Rate for Payer: Cigna of CA HMO |
$6,124.16
|
| Rate for Payer: Cigna of CA PPO |
$7,081.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,133.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,741.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,612.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$358.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,382.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$7,176.75
|
| Rate for Payer: Networks By Design Commercial |
$6,219.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Prime Health Services Commercial |
$8,133.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,741.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,741.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC VAGINAL REPAIR
|
Facility
|
IP
|
$9,569.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
902400755
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,913.80 |
| Max. Negotiated Rate |
$8,612.10 |
| Rate for Payer: Adventist Health Commercial |
$1,913.80
|
| Rate for Payer: Cash Price |
$5,262.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,827.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,827.60
|
| Rate for Payer: Galaxy Health WC |
$8,133.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,741.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,612.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,382.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,645.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,923.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.80
|
| Rate for Payer: Multiplan Commercial |
$7,176.75
|
| Rate for Payer: Networks By Design Commercial |
$6,219.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,133.65
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$70.41
|
| Rate for Payer: Blue Shield of California EPN |
$46.05
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: EPIC Health Plan Senior |
$13.54
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: InnovAge PACE Commercial |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.54
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Prime Health Services Medicare |
$14.35
|
| Rate for Payer: Riverside University Health System MISP |
$14.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC VALVE ANTI-REFLUXALE KIT
|
Facility
|
IP
|
$25.17
|
|
| Hospital Charge Code |
901605441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Adventist Health Commercial |
$5.03
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Central Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: EPIC Health Plan Senior |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.03
|
| Rate for Payer: Multiplan Commercial |
$18.88
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
|
|
HC VALVE ANTI-REFLUXALE KIT
|
Facility
|
OP
|
$25.17
|
|
| Hospital Charge Code |
901605441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Adventist Health Commercial |
$5.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.78
|
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.04
|
| Rate for Payer: Cash Price |
$13.84
|
| Rate for Payer: Central Health Plan Commercial |
$20.14
|
| Rate for Payer: Cigna of CA HMO |
$16.11
|
| Rate for Payer: Cigna of CA PPO |
$18.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: EPIC Health Plan Senior |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.65
|
| Rate for Payer: InnovAge PACE Commercial |
$12.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$18.88
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
| Rate for Payer: Riverside University Health System MISP |
$10.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.59
|
| Rate for Payer: United Healthcare All Other HMO |
$12.59
|
| Rate for Payer: United Healthcare HMO Rider |
$12.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.39
|
| Rate for Payer: Vantage Medical Group Senior |
$21.39
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM
|
Facility
|
OP
|
$48,750.00
|
|
| Hospital Charge Code |
906812483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$43,875.00 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,259.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,992.88
|
| Rate for Payer: Blue Shield of California Commercial |
$37,683.75
|
| Rate for Payer: Blue Shield of California EPN |
$24,570.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$39,000.00
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$24,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,125.00
|
| Rate for Payer: Multiplan Commercial |
$36,562.50
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: Riverside University Health System MISP |
$19,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$41,437.50
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM
|
Facility
|
IP
|
$48,750.00
|
|
| Hospital Charge Code |
906812483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$43,875.00 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37,683.75
|
| Rate for Payer: Blue Shield of California EPN |
$24,570.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$39,000.00
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,750.00
|
| Rate for Payer: Multiplan Commercial |
$36,562.50
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM 3
|
Facility
|
OP
|
$48,750.00
|
|
| Hospital Charge Code |
906812561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$43,875.00 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,259.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,992.88
|
| Rate for Payer: Blue Shield of California Commercial |
$37,683.75
|
| Rate for Payer: Blue Shield of California EPN |
$24,570.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$39,000.00
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$24,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,125.00
|
| Rate for Payer: Multiplan Commercial |
$36,562.50
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: Riverside University Health System MISP |
$19,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$41,437.50
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM 3
|
Facility
|
IP
|
$48,750.00
|
|
| Hospital Charge Code |
906812561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$43,875.00 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37,683.75
|
| Rate for Payer: Blue Shield of California EPN |
$24,570.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$39,000.00
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,750.00
|
| Rate for Payer: Multiplan Commercial |
$36,562.50
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM XT
|
Facility
|
OP
|
$48,750.00
|
|
| Hospital Charge Code |
906812535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$43,875.00 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,812.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,259.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,992.88
|
| Rate for Payer: Blue Shield of California Commercial |
$37,683.75
|
| Rate for Payer: Blue Shield of California EPN |
$24,570.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$39,000.00
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,437.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,437.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,875.00
|
| Rate for Payer: InnovAge PACE Commercial |
$24,375.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,125.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,125.00
|
| Rate for Payer: Multiplan Commercial |
$36,562.50
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: Riverside University Health System MISP |
$19,500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,250.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,437.50
|
| Rate for Payer: Vantage Medical Group Senior |
$41,437.50
|
|
|
HC VALVE EDWARDS SAPIEN SYSTEM XT
|
Facility
|
IP
|
$48,750.00
|
|
| Hospital Charge Code |
906812535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$43,875.00 |
| Rate for Payer: Adventist Health Commercial |
$9,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37,683.75
|
| Rate for Payer: Blue Shield of California EPN |
$24,570.00
|
| Rate for Payer: Cash Price |
$26,812.50
|
| Rate for Payer: Central Health Plan Commercial |
$39,000.00
|
| Rate for Payer: Cigna of CA HMO |
$34,125.00
|
| Rate for Payer: Cigna of CA PPO |
$34,125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,500.00
|
| Rate for Payer: Galaxy Health WC |
$41,437.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,250.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,516.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,573.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,176.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,750.00
|
| Rate for Payer: Multiplan Commercial |
$36,562.50
|
| Rate for Payer: Networks By Design Commercial |
$24,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$41,437.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,295.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,808.38
|
| Rate for Payer: United Healthcare HMO Rider |
$17,423.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,965.62
|
|
|
HC VALVE HEIMLICH
|
Facility
|
OP
|
$274.89
|
|
| Hospital Charge Code |
901600145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$247.40 |
| Rate for Payer: Adventist Health Commercial |
$54.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$233.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$206.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.44
|
| Rate for Payer: Blue Shield of California Commercial |
$167.96
|
| Rate for Payer: Blue Shield of California EPN |
$109.68
|
| Rate for Payer: Cash Price |
$151.19
|
| Rate for Payer: Central Health Plan Commercial |
$219.91
|
| Rate for Payer: Cigna of CA HMO |
$175.93
|
| Rate for Payer: Cigna of CA PPO |
$203.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$233.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$233.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.96
|
| Rate for Payer: EPIC Health Plan Senior |
$109.96
|
| Rate for Payer: Galaxy Health WC |
$233.66
|
| Rate for Payer: Global Benefits Group Commercial |
$164.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.40
|
| Rate for Payer: InnovAge PACE Commercial |
$137.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.42
|
| Rate for Payer: Multiplan Commercial |
$206.17
|
| Rate for Payer: Networks By Design Commercial |
$178.68
|
| Rate for Payer: Prime Health Services Commercial |
$233.66
|
| Rate for Payer: Riverside University Health System MISP |
$109.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.44
|
| Rate for Payer: United Healthcare All Other HMO |
$137.44
|
| Rate for Payer: United Healthcare HMO Rider |
$137.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$233.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$233.66
|
| Rate for Payer: Vantage Medical Group Senior |
$233.66
|
|
|
HC VALVE HEIMLICH
|
Facility
|
IP
|
$274.89
|
|
| Hospital Charge Code |
901600145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$247.40 |
| Rate for Payer: Adventist Health Commercial |
$54.98
|
| Rate for Payer: Cash Price |
$151.19
|
| Rate for Payer: Central Health Plan Commercial |
$219.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.96
|
| Rate for Payer: EPIC Health Plan Senior |
$109.96
|
| Rate for Payer: Galaxy Health WC |
$233.66
|
| Rate for Payer: Global Benefits Group Commercial |
$164.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.98
|
| Rate for Payer: Multiplan Commercial |
$206.17
|
| Rate for Payer: Networks By Design Commercial |
$178.68
|
| Rate for Payer: Prime Health Services Commercial |
$233.66
|
|
|
HC VALVE MED MELODY PB10
|
Facility
|
OP
|
$36,000.00
|
|
| Hospital Charge Code |
906812446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$32,400.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,800.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,000.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,437.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,933.20
|
| Rate for Payer: Blue Shield of California Commercial |
$27,828.00
|
| Rate for Payer: Blue Shield of California EPN |
$18,144.00
|
| Rate for Payer: Cash Price |
$19,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$28,800.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,600.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,400.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,716.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,200.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,200.00
|
| Rate for Payer: Multiplan Commercial |
$27,000.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: Riverside University Health System MISP |
$14,400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,600.00
|
| Rate for Payer: Vantage Medical Group Senior |
$30,600.00
|
|
|
HC VALVE MED MELODY PB10
|
Facility
|
IP
|
$36,000.00
|
|
| Hospital Charge Code |
906812446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,200.00 |
| Max. Negotiated Rate |
$32,400.00 |
| Rate for Payer: Adventist Health Commercial |
$7,200.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27,828.00
|
| Rate for Payer: Blue Shield of California EPN |
$18,144.00
|
| Rate for Payer: Cash Price |
$19,800.00
|
| Rate for Payer: Central Health Plan Commercial |
$28,800.00
|
| Rate for Payer: Cigna of CA HMO |
$25,200.00
|
| Rate for Payer: Cigna of CA PPO |
$25,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,400.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,400.00
|
| Rate for Payer: Galaxy Health WC |
$30,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$21,600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,400.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,716.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,284.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,200.00
|
| Rate for Payer: Multiplan Commercial |
$27,000.00
|
| Rate for Payer: Networks By Design Commercial |
$18,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$30,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,510.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13,150.80
|
| Rate for Payer: United Healthcare HMO Rider |
$12,866.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,790.00
|
|
|
HC VALVE PASSY MUIR (PURPLE)
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
901603797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC VALVE PASSY MUIR (PURPLE)
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
901605980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
