|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$389.70 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Blue Shield of California Commercial |
$334.71
|
| Rate for Payer: Blue Shield of California EPN |
$218.23
|
| Rate for Payer: Cash Price |
$238.15
|
| Rate for Payer: Central Health Plan Commercial |
$346.40
|
| Rate for Payer: Cigna of CA HMO |
$303.10
|
| Rate for Payer: Cigna of CA PPO |
$303.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$173.20
|
| Rate for Payer: Galaxy Health WC |
$368.05
|
| Rate for Payer: Global Benefits Group Commercial |
$259.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$389.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.60
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| Rate for Payer: Networks By Design Commercial |
$216.50
|
| Rate for Payer: Prime Health Services Commercial |
$368.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$158.17
|
| Rate for Payer: United Healthcare HMO Rider |
$154.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.81
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Blue Shield of California Commercial |
$251.22
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.87
|
| Rate for Payer: Blue Shield of California Commercial |
$198.57
|
| Rate for Payer: Blue Shield of California EPN |
$129.68
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$162.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Riverside University Health System MISP |
$130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| 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: Blue Shield of California Commercial |
$763.75
|
| Rate for Payer: Blue Shield of California EPN |
$498.75
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,389.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,363.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,079.39
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| 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 |
$3,820.30
|
| Rate for Payer: Cash Price |
$3,820.30
|
| Rate for Payer: Cash Price |
$3,820.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,556.80
|
| Rate for Payer: Cigna of CA HMO |
$4,445.44
|
| Rate for Payer: Cigna of CA PPO |
$5,140.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,904.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,167.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,251.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,511.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,632.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,669.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$5,209.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,514.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,904.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,167.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,389.20 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Adventist Health Commercial |
$1,389.20
|
| Rate for Payer: Cash Price |
$3,820.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,778.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,778.40
|
| Rate for Payer: Galaxy Health WC |
$5,904.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,167.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,251.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,632.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,646.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,299.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.20
|
| Rate for Payer: Multiplan Commercial |
$5,209.50
|
| Rate for Payer: Networks By Design Commercial |
$4,514.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,904.10
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$13,983.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,354.76 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,796.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$7,690.65
|
| Rate for Payer: Cash Price |
$7,690.65
|
| Rate for Payer: Cash Price |
$7,690.65
|
| Rate for Payer: Central Health Plan Commercial |
$11,186.40
|
| Rate for Payer: Cigna of CA HMO |
$9,088.95
|
| Rate for Payer: Cigna of CA PPO |
$10,347.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$11,885.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8,389.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,584.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,354.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,326.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,496.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,796.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$10,487.25
|
| Rate for Payer: Networks By Design Commercial |
$9,088.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$11,885.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,389.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$16,451.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906820059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,354.76 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,290.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$9,048.05
|
| Rate for Payer: Cash Price |
$9,048.05
|
| Rate for Payer: Cash Price |
$9,048.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,160.80
|
| Rate for Payer: Cigna of CA HMO |
$10,693.15
|
| Rate for Payer: Cigna of CA PPO |
$12,173.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$13,983.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,870.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,805.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,354.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,972.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,496.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,290.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$12,338.25
|
| Rate for Payer: Networks By Design Commercial |
$10,693.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$13,983.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,870.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$16,451.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906820059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,290.20 |
| Max. Negotiated Rate |
$14,805.90 |
| Rate for Payer: Adventist Health Commercial |
$3,290.20
|
| Rate for Payer: Cash Price |
$9,048.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,580.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,580.40
|
| Rate for Payer: Galaxy Health WC |
$13,983.35
|
| Rate for Payer: Global Benefits Group Commercial |
$9,870.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,805.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,972.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,267.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,183.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,290.20
|
| Rate for Payer: Multiplan Commercial |
$12,338.25
|
| Rate for Payer: Networks By Design Commercial |
$10,693.15
|
| Rate for Payer: Prime Health Services Commercial |
$13,983.35
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$13,983.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,796.60 |
| Max. Negotiated Rate |
$12,584.70 |
| Rate for Payer: Adventist Health Commercial |
$2,796.60
|
| Rate for Payer: Cash Price |
$7,690.65
|
| Rate for Payer: Central Health Plan Commercial |
$11,186.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,593.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,593.20
|
| Rate for Payer: Galaxy Health WC |
$11,885.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8,389.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,584.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,326.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,327.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,655.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,796.60
|
| Rate for Payer: Multiplan Commercial |
$10,487.25
|
| Rate for Payer: Networks By Design Commercial |
$9,088.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,885.55
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
IP
|
$11,967.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,393.40 |
| Max. Negotiated Rate |
$10,770.30 |
| Rate for Payer: Adventist Health Commercial |
$2,393.40
|
| Rate for Payer: Cash Price |
$6,581.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,573.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,786.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,786.80
|
| Rate for Payer: Galaxy Health WC |
$10,171.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,180.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,770.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,981.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,559.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,407.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.40
|
| Rate for Payer: Multiplan Commercial |
$8,975.25
|
| Rate for Payer: Networks By Design Commercial |
$7,778.55
|
| Rate for Payer: Prime Health Services Commercial |
$10,171.95
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
OP
|
$14,079.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906820060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,581.52 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,815.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$7,743.45
|
| Rate for Payer: Cash Price |
$7,743.45
|
| Rate for Payer: Cash Price |
$7,743.45
|
| Rate for Payer: Central Health Plan Commercial |
$11,263.20
|
| Rate for Payer: Cigna of CA HMO |
$9,151.35
|
| Rate for Payer: Cigna of CA PPO |
$10,418.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$11,967.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,447.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,671.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,581.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,390.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,747.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,815.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$10,559.25
|
| Rate for Payer: Networks By Design Commercial |
$9,151.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$11,967.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,447.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
OP
|
$11,967.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,581.52 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,393.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| 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 |
$6,581.85
|
| Rate for Payer: Cash Price |
$6,581.85
|
| Rate for Payer: Cash Price |
$6,581.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,573.60
|
| Rate for Payer: Cigna of CA HMO |
$7,778.55
|
| Rate for Payer: Cigna of CA PPO |
$8,855.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$10,171.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,180.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,770.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,581.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,981.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,747.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$8,975.25
|
| Rate for Payer: Networks By Design Commercial |
$7,778.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$10,171.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,180.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| 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 |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
IP
|
$14,079.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906820060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,815.80 |
| Max. Negotiated Rate |
$12,671.10 |
| Rate for Payer: Adventist Health Commercial |
$2,815.80
|
| Rate for Payer: Cash Price |
$7,743.45
|
| Rate for Payer: Central Health Plan Commercial |
$11,263.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,631.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,631.60
|
| Rate for Payer: Galaxy Health WC |
$11,967.15
|
| Rate for Payer: Global Benefits Group Commercial |
$8,447.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,671.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,390.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,364.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,714.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,815.80
|
| Rate for Payer: Multiplan Commercial |
$10,559.25
|
| Rate for Payer: Networks By Design Commercial |
$9,151.35
|
| Rate for Payer: Prime Health Services Commercial |
$11,967.15
|
|
|
HC CORONARY CTA W/MORPH W/O CCS
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,574.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,896.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,991.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.60
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
|
|
HC CORONARY CTA W/MORPH W/O CCS
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,507.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,889.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,953.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,277.55
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Center for Health Promotion Commercial |
$255.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,574.40
|
| Rate for Payer: Cigna of CA HMO |
$2,059.52
|
| Rate for Payer: Cigna of CA PPO |
$2,381.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,896.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$536.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$9,397.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906820240
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,879.40 |
| Max. Negotiated Rate |
$8,457.30 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Cash Price |
$5,168.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,517.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,758.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,758.80
|
| Rate for Payer: Galaxy Health WC |
$7,987.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,638.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,457.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,267.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,580.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,816.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,879.40
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
| Rate for Payer: Networks By Design Commercial |
$6,108.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,987.45
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$7,987.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,597.40 |
| Max. Negotiated Rate |
$7,188.30 |
| Rate for Payer: Adventist Health Commercial |
$1,597.40
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,389.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,194.80
|
| Rate for Payer: Galaxy Health WC |
$6,788.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,792.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,188.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,043.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,943.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.40
|
| Rate for Payer: Multiplan Commercial |
$5,990.25
|
| Rate for Payer: Networks By Design Commercial |
$5,191.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,788.95
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
OP
|
$9,397.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906820240
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,879.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,168.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,047.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$5,168.35
|
| Rate for Payer: Cash Price |
$5,168.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,517.60
|
| Rate for Payer: Cigna of CA HMO |
$6,108.05
|
| Rate for Payer: Cigna of CA PPO |
$6,953.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,987.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,987.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,758.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,758.80
|
| Rate for Payer: Galaxy Health WC |
$7,987.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,638.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,457.30
|
| Rate for Payer: InnovAge PACE Commercial |
$4,698.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,267.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,816.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,879.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,577.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,577.90
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
| Rate for Payer: Networks By Design Commercial |
$6,108.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,987.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,758.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,638.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,638.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,987.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,987.45
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
OP
|
$7,987.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,597.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,597.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,788.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,392.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,990.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,389.60
|
| Rate for Payer: Cigna of CA HMO |
$5,191.55
|
| Rate for Payer: Cigna of CA PPO |
$5,910.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,788.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,788.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,788.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,194.80
|
| Rate for Payer: Galaxy Health WC |
$6,788.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,792.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,188.30
|
| Rate for Payer: InnovAge PACE Commercial |
$3,993.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,327.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,943.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,597.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,590.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,590.90
|
| Rate for Payer: Multiplan Commercial |
$5,990.25
|
| Rate for Payer: Networks By Design Commercial |
$5,191.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,788.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,194.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,792.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,792.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$6,788.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,788.95
|
| Rate for Payer: Vantage Medical Group Senior |
$6,788.95
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
OP
|
$26,699.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906820258
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$24,029.10 |
| Rate for Payer: Adventist Health Commercial |
$5,339.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,684.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,024.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$14,684.45
|
| Rate for Payer: Cash Price |
$14,684.45
|
| Rate for Payer: Central Health Plan Commercial |
$21,359.20
|
| Rate for Payer: Cigna of CA HMO |
$17,087.36
|
| Rate for Payer: Cigna of CA PPO |
$19,757.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,694.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,694.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,679.60
|
| Rate for Payer: Galaxy Health WC |
$22,694.15
|
| Rate for Payer: Global Benefits Group Commercial |
$16,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,029.10
|
| Rate for Payer: InnovAge PACE Commercial |
$13,349.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,808.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,172.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,526.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,339.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,689.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,689.30
|
| Rate for Payer: Multiplan Commercial |
$20,024.25
|
| Rate for Payer: Networks By Design Commercial |
$17,354.35
|
| Rate for Payer: Prime Health Services Commercial |
$22,694.15
|
| Rate for Payer: Riverside University Health System MISP |
$10,679.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,019.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,019.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,694.15
|
| Rate for Payer: Vantage Medical Group Senior |
$22,694.15
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
OP
|
$22,694.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$20,424.60 |
| Rate for Payer: Adventist Health Commercial |
$4,538.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,289.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,481.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,020.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$12,481.70
|
| Rate for Payer: Cash Price |
$12,481.70
|
| Rate for Payer: Central Health Plan Commercial |
$18,155.20
|
| Rate for Payer: Cigna of CA HMO |
$14,524.16
|
| Rate for Payer: Cigna of CA PPO |
$16,793.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,289.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,289.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,289.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,077.60
|
| Rate for Payer: Galaxy Health WC |
$19,289.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,616.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,424.60
|
| Rate for Payer: InnovAge PACE Commercial |
$11,347.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,646.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,047.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,538.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,885.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,885.80
|
| Rate for Payer: Multiplan Commercial |
$17,020.50
|
| Rate for Payer: Networks By Design Commercial |
$14,751.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,289.90
|
| Rate for Payer: Riverside University Health System MISP |
$9,077.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,616.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,616.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,289.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,289.90
|
| Rate for Payer: Vantage Medical Group Senior |
$19,289.90
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
IP
|
$26,699.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906820258
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,339.80 |
| Max. Negotiated Rate |
$24,029.10 |
| Rate for Payer: Adventist Health Commercial |
$5,339.80
|
| Rate for Payer: Cash Price |
$14,684.45
|
| Rate for Payer: Central Health Plan Commercial |
$21,359.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,679.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,679.60
|
| Rate for Payer: Galaxy Health WC |
$22,694.15
|
| Rate for Payer: Global Benefits Group Commercial |
$16,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,029.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,808.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,172.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,526.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,339.80
|
| Rate for Payer: Multiplan Commercial |
$20,024.25
|
| Rate for Payer: Networks By Design Commercial |
$17,354.35
|
| Rate for Payer: Prime Health Services Commercial |
$22,694.15
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
IP
|
$22,694.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,538.80 |
| Max. Negotiated Rate |
$20,424.60 |
| Rate for Payer: Adventist Health Commercial |
$4,538.80
|
| Rate for Payer: Cash Price |
$12,481.70
|
| Rate for Payer: Central Health Plan Commercial |
$18,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,077.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,077.60
|
| Rate for Payer: Galaxy Health WC |
$19,289.90
|
| Rate for Payer: Global Benefits Group Commercial |
$13,616.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,424.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,136.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,646.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,047.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,538.80
|
| Rate for Payer: Multiplan Commercial |
$17,020.50
|
| Rate for Payer: Networks By Design Commercial |
$14,751.10
|
| Rate for Payer: Prime Health Services Commercial |
$19,289.90
|
|
