|
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
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$18,185.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906820030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,637.00 |
| Max. Negotiated Rate |
$16,366.50 |
| Rate for Payer: Adventist Health Commercial |
$3,637.00
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,548.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,274.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,274.00
|
| Rate for Payer: Galaxy Health WC |
$15,457.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,911.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,366.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,928.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,256.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Multiplan Commercial |
$13,638.75
|
| Rate for Payer: Networks By Design Commercial |
$11,820.25
|
| Rate for Payer: Prime Health Services Commercial |
$15,457.25
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$18,185.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906820030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,661.31 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,637.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,548.00
|
| Rate for Payer: Cigna of CA HMO |
$11,820.25
|
| Rate for Payer: Cigna of CA PPO |
$13,456.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$15,457.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,911.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,366.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,661.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,835.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$13,638.75
|
| Rate for Payer: Networks By Design Commercial |
$11,820.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Prime Health Services Commercial |
$15,457.25
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,911.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,911.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$15,457.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,661.31 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,091.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,244.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Central Health Plan Commercial |
$12,365.60
|
| Rate for Payer: Cigna of CA HMO |
$10,047.05
|
| Rate for Payer: Cigna of CA PPO |
$11,438.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$13,138.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,911.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,661.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,866.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,309.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,835.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,091.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,707.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$11,592.75
|
| Rate for Payer: Networks By Design Commercial |
$10,047.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Prime Health Services Commercial |
$13,138.45
|
| Rate for Payer: Prime Health Services Medicare |
$7,679.01
|
| Rate for Payer: Riverside University Health System MISP |
$7,968.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,274.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,274.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$15,457.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,091.40 |
| Max. Negotiated Rate |
$13,911.30 |
| Rate for Payer: Adventist Health Commercial |
$3,091.40
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Central Health Plan Commercial |
$12,365.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,182.80
|
| Rate for Payer: Galaxy Health WC |
$13,138.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,911.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,309.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,889.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,567.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,091.40
|
| Rate for Payer: Multiplan Commercial |
$11,592.75
|
| Rate for Payer: Networks By Design Commercial |
$10,047.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,138.45
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$12,123.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906820033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$359.08 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,424.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,698.40
|
| Rate for Payer: Cigna of CA HMO |
$7,879.95
|
| Rate for Payer: Cigna of CA PPO |
$8,971.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$10,304.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,273.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,910.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,086.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,424.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$9,092.25
|
| Rate for Payer: Networks By Design Commercial |
$7,879.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$10,304.55
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,273.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,273.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$10,305.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$359.08 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,061.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,244.00
|
| Rate for Payer: Cigna of CA HMO |
$6,698.25
|
| Rate for Payer: Cigna of CA PPO |
$7,625.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$8,759.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,274.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,873.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$7,728.75
|
| Rate for Payer: Networks By Design Commercial |
$6,698.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$8,759.25
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$10,305.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,061.00 |
| Max. Negotiated Rate |
$9,274.50 |
| Rate for Payer: Adventist Health Commercial |
$2,061.00
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Central Health Plan Commercial |
$8,244.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.00
|
| Rate for Payer: Galaxy Health WC |
$8,759.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,873.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,926.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,378.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.00
|
| Rate for Payer: Multiplan Commercial |
$7,728.75
|
| Rate for Payer: Networks By Design Commercial |
$6,698.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,759.25
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$12,123.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906820033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,424.60 |
| Max. Negotiated Rate |
$10,910.70 |
| Rate for Payer: Adventist Health Commercial |
$2,424.60
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Central Health Plan Commercial |
$9,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,849.20
|
| Rate for Payer: Galaxy Health WC |
$10,304.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,273.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,910.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,086.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,618.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,504.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,424.60
|
| Rate for Payer: Multiplan Commercial |
$9,092.25
|
| Rate for Payer: Networks By Design Commercial |
$7,879.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,304.55
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$13,401.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,680.20 |
| Max. Negotiated Rate |
$12,060.90 |
| Rate for Payer: Adventist Health Commercial |
$2,680.20
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,720.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,360.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,360.40
|
| Rate for Payer: Galaxy Health WC |
$11,390.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,040.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,060.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,938.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,105.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,295.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,680.20
|
| Rate for Payer: Multiplan Commercial |
$10,050.75
|
| Rate for Payer: Networks By Design Commercial |
$8,710.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,390.85
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$13,401.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,408.71 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,680.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Central Health Plan Commercial |
$10,720.80
|
| Rate for Payer: Cigna of CA HMO |
$8,710.65
|
| Rate for Payer: Cigna of CA PPO |
$9,916.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$11,390.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,040.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,060.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,408.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,938.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,680.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$10,050.75
|
| Rate for Payer: Networks By Design Commercial |
$8,710.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$11,390.85
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,040.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,040.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,278.20 |
| Max. Negotiated Rate |
$10,251.90 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,556.40
|
| Rate for Payer: Galaxy Health WC |
$9,682.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,834.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,251.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,597.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,339.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,051.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,278.20
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
| Rate for Payer: Networks By Design Commercial |
$7,404.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,682.35
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,408.71 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Central Health Plan Commercial |
$9,112.80
|
| Rate for Payer: Cigna of CA HMO |
$7,404.15
|
| Rate for Payer: Cigna of CA PPO |
$8,429.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$9,682.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,834.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,251.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,408.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,597.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,278.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
| Rate for Payer: Networks By Design Commercial |
$7,404.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$9,682.35
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,834.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,834.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VANCOMYCIN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$98.54 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| 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 |
$30.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| 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 |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| 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 |
$34.02
|
| 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 |
$10.20
|
| 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 |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.54
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| 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 |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| 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 VANCOMYCIN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC VANCOMYCIN PEAK
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900912232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$98.54 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.97
|
| 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 |
$30.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.25
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Cash Price |
$28.05
|
| Rate for Payer: Central Health Plan Commercial |
$40.80
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| 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 |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.90
|
| 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 |
$34.02
|
| 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 |
$10.20
|
| 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 |
$38.25
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.54
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| 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 |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| 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 VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC VANILLYLMANDELIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$112.79 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.85
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: EPIC Health Plan Senior |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: InnovAge PACE Commercial |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$112.79 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.85
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: EPIC Health Plan Senior |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: InnovAge PACE Commercial |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VANILLYLMANDELIC ACID URINE RANDOM
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900912224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$112.79 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.89
|
| Rate for Payer: Blue Shield of California Commercial |
$21.85
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: EPIC Health Plan Senior |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: InnovAge PACE Commercial |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$16.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$207.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.38
|
| Rate for Payer: Blue Shield of California Commercial |
$350.94
|
| Rate for Payer: Blue Shield of California EPN |
$228.82
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Central Health Plan Commercial |
$363.20
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$385.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$408.60
|
| Rate for Payer: InnovAge PACE Commercial |
$227.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$340.50
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: Riverside University Health System MISP |
$181.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
