|
HC ABLATION CRYO SPRAY
|
Facility
|
IP
|
$4,875.00
|
|
| Hospital Charge Code |
900800272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$11,238.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$604.50
|
| Rate for Payer: Cigna of CA PPO |
$688.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.55
|
| Rate for Payer: InnovAge PACE Commercial |
$465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Riverside University Health System MISP |
$372.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$11,238.00 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Central Health Plan Commercial |
$875.20
|
| Rate for Payer: Cigna of CA HMO |
$711.10
|
| Rate for Payer: Cigna of CA PPO |
$809.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.60
|
| Rate for Payer: EPIC Health Plan Senior |
$437.60
|
| Rate for Payer: Galaxy Health WC |
$929.90
|
| Rate for Payer: Global Benefits Group Commercial |
$656.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$984.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.55
|
| Rate for Payer: InnovAge PACE Commercial |
$547.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: Networks By Design Commercial |
$711.10
|
| Rate for Payer: Prime Health Services Commercial |
$929.90
|
| Rate for Payer: Riverside University Health System MISP |
$437.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$656.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$656.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$13,532.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$567.26 |
| Max. Negotiated Rate |
$12,178.80 |
| Rate for Payer: Adventist Health Commercial |
$2,706.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,502.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,442.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,149.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$7,442.60
|
| Rate for Payer: Cash Price |
$7,442.60
|
| Rate for Payer: Cash Price |
$7,442.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,825.60
|
| Rate for Payer: Cigna of CA HMO |
$8,795.80
|
| Rate for Payer: Cigna of CA PPO |
$10,013.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,502.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,502.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,502.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,412.80
|
| Rate for Payer: Galaxy Health WC |
$11,502.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,119.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,178.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,766.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,025.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,376.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,472.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,472.40
|
| Rate for Payer: Multiplan Commercial |
$10,149.00
|
| Rate for Payer: Networks By Design Commercial |
$8,795.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,502.20
|
| Rate for Payer: Riverside University Health System MISP |
$5,412.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,119.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,119.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,502.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,502.20
|
| Rate for Payer: Vantage Medical Group Senior |
$11,502.20
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$13,532.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,706.40 |
| Max. Negotiated Rate |
$12,178.80 |
| Rate for Payer: Adventist Health Commercial |
$2,706.40
|
| Rate for Payer: Cash Price |
$7,442.60
|
| Rate for Payer: Central Health Plan Commercial |
$10,825.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,412.80
|
| Rate for Payer: Galaxy Health WC |
$11,502.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,119.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,178.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,025.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,155.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,376.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.40
|
| Rate for Payer: Multiplan Commercial |
$10,149.00
|
| Rate for Payer: Networks By Design Commercial |
$8,795.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,502.20
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$15,920.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$567.26 |
| Max. Negotiated Rate |
$14,328.00 |
| Rate for Payer: Adventist Health Commercial |
$3,184.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,532.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,756.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,940.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,736.00
|
| Rate for Payer: Cigna of CA HMO |
$10,348.00
|
| Rate for Payer: Cigna of CA PPO |
$11,780.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,532.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,532.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,368.00
|
| Rate for Payer: Galaxy Health WC |
$13,532.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,552.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,328.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$567.26
|
| Rate for Payer: InnovAge PACE Commercial |
$7,960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,618.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,854.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,184.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,144.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,144.00
|
| Rate for Payer: Multiplan Commercial |
$11,940.00
|
| Rate for Payer: Networks By Design Commercial |
$10,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,532.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,368.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,552.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,552.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,532.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,532.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,532.00
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$15,920.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,184.00 |
| Max. Negotiated Rate |
$14,328.00 |
| Rate for Payer: Adventist Health Commercial |
$3,184.00
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,736.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,368.00
|
| Rate for Payer: Galaxy Health WC |
$13,532.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,552.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,328.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,618.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,065.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,854.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,184.00
|
| Rate for Payer: Multiplan Commercial |
$11,940.00
|
| Rate for Payer: Networks By Design Commercial |
$10,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,532.00
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.80 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$225.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$304.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Central Health Plan Commercial |
$903.20
|
| Rate for Payer: Cigna of CA HMO |
$722.56
|
| Rate for Payer: Cigna of CA PPO |
$835.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$959.65
|
| Rate for Payer: Global Benefits Group Commercial |
$677.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,016.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$846.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$733.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$959.65
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$677.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.80 |
| Max. Negotiated Rate |
$1,016.10 |
| Rate for Payer: Adventist Health Commercial |
$225.80
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Central Health Plan Commercial |
$903.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.60
|
| Rate for Payer: EPIC Health Plan Senior |
$451.60
|
| Rate for Payer: Galaxy Health WC |
$959.65
|
| Rate for Payer: Global Benefits Group Commercial |
$677.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,016.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$698.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.80
|
| Rate for Payer: Multiplan Commercial |
$846.75
|
| Rate for Payer: Networks By Design Commercial |
$733.85
|
| Rate for Payer: Prime Health Services Commercial |
$959.65
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.19 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Cigna of CA HMO |
$4,602.88
|
| Rate for Payer: Cigna of CA PPO |
$5,322.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,630.06
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,438.40 |
| Max. Negotiated Rate |
$6,472.80 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,876.80
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,451.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
IP
|
$43,984.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,796.80 |
| Max. Negotiated Rate |
$39,585.60 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,593.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,593.60
|
| Rate for Payer: Galaxy Health WC |
$37,386.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,390.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,585.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,337.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,757.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,226.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,796.80
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
| Rate for Payer: Networks By Design Commercial |
$28,589.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,386.40
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
OP
|
$43,984.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$39,585.60 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,228.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,297.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,831.80
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,187.20
|
| Rate for Payer: Cigna of CA HMO |
$28,149.76
|
| Rate for Payer: Cigna of CA PPO |
$32,548.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$37,386.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,390.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,585.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: InnovAge PACE Commercial |
$19,842.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,337.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,757.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,796.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,726.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$28,589.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Commercial |
$37,386.40
|
| Rate for Payer: Prime Health Services Medicare |
$14,022.21
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$14,551.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,390.40
|
| 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 |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
IP
|
$43,984.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,796.80 |
| Max. Negotiated Rate |
$39,585.60 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,187.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,593.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,593.60
|
| Rate for Payer: Galaxy Health WC |
$37,386.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,390.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,585.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,337.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,757.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,226.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,796.80
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
| Rate for Payer: Networks By Design Commercial |
$28,589.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,386.40
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
OP
|
$43,984.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$39,585.60 |
| Rate for Payer: Adventist Health Commercial |
$8,796.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,228.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,228.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,297.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,831.80
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Cash Price |
$24,191.20
|
| Rate for Payer: Central Health Plan Commercial |
$35,187.20
|
| Rate for Payer: Cigna of CA HMO |
$28,149.76
|
| Rate for Payer: Cigna of CA PPO |
$32,548.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,551.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,858.47
|
| Rate for Payer: EPIC Health Plan Senior |
$13,228.50
|
| Rate for Payer: Galaxy Health WC |
$37,386.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,390.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,585.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,694.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,228.50
|
| Rate for Payer: InnovAge PACE Commercial |
$19,842.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,337.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,757.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,228.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,796.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,726.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,726.19
|
| Rate for Payer: Multiplan Commercial |
$32,988.00
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: Networks By Design Commercial |
$28,589.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,228.50
|
| Rate for Payer: Preferred Health Network WC |
$21,507.40
|
| Rate for Payer: Prime Health Services Commercial |
$37,386.40
|
| Rate for Payer: Prime Health Services Medicare |
$14,022.21
|
| Rate for Payer: Prime Health Services WC |
$20,862.18
|
| Rate for Payer: Riverside University Health System MISP |
$14,551.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,390.40
|
| 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 |
$13,228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,842.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,551.35
|
| Rate for Payer: Vantage Medical Group Senior |
$13,228.50
|
|
|
HC ABL PERC CRYOABLATION INCL IG; LE DISTAL PN
|
Facility
|
IP
|
$6,936.00
|
|
|
Service Code
|
CPT 0441T
|
| Hospital Charge Code |
909081441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,387.20 |
| Max. Negotiated Rate |
$6,242.40 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,774.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,774.40
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,642.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,293.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
|
|
HC ABL PERC CRYOABLATION INCL IG; LE DISTAL PN
|
Facility
|
OP
|
$6,936.00
|
|
|
Service Code
|
CPT 0441T
|
| Hospital Charge Code |
909081441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,387.20 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Cash Price |
$3,814.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: Cigna of CA HMO |
$4,439.04
|
| Rate for Payer: Cigna of CA PPO |
$5,132.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,642.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,630.06
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.40
|
| Rate for Payer: Blue Shield of California Commercial |
$153.57
|
| Rate for Payer: Blue Shield of California EPN |
$100.44
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.59
|
| Rate for Payer: Blue Shield of California Commercial |
$154.58
|
| Rate for Payer: Blue Shield of California EPN |
$100.95
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
IP
|
$7.13
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
|
|
HC ABSORBNT SHEET 6X14",BAG OF 10
|
Facility
|
OP
|
$7.13
|
|
| Hospital Charge Code |
901607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4.36
|
| Rate for Payer: Blue Shield of California EPN |
$2.84
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.70
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$5.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.42
|
| Rate for Payer: InnovAge PACE Commercial |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$5.35
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
| Rate for Payer: Riverside University Health System MISP |
$2.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.06
|
|
