|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$23,492.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906820239
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,698.40 |
| Max. Negotiated Rate |
$21,142.80 |
| Rate for Payer: Adventist Health Commercial |
$4,698.40
|
| Rate for Payer: Cash Price |
$12,920.60
|
| Rate for Payer: Central Health Plan Commercial |
$18,793.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,396.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,396.80
|
| Rate for Payer: Galaxy Health WC |
$19,968.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14,095.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,142.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,669.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,950.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,541.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,698.40
|
| Rate for Payer: Multiplan Commercial |
$17,619.00
|
| Rate for Payer: Networks By Design Commercial |
$15,269.80
|
| Rate for Payer: Prime Health Services Commercial |
$19,968.20
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$19,968.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,993.60 |
| Max. Negotiated Rate |
$17,971.20 |
| Rate for Payer: Adventist Health Commercial |
$3,993.60
|
| Rate for Payer: Cash Price |
$10,982.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,974.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,987.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,987.20
|
| Rate for Payer: Galaxy Health WC |
$16,972.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,980.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,971.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,318.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,607.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,360.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,993.60
|
| Rate for Payer: Multiplan Commercial |
$14,976.00
|
| Rate for Payer: Networks By Design Commercial |
$12,979.20
|
| Rate for Payer: Prime Health Services Commercial |
$16,972.80
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$19,968.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$830.85 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,993.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$10,982.40
|
| Rate for Payer: Cash Price |
$10,982.40
|
| Rate for Payer: Cash Price |
$10,982.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,974.40
|
| Rate for Payer: Cigna of CA HMO |
$12,979.20
|
| Rate for Payer: Cigna of CA PPO |
$14,776.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$16,972.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,980.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,971.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$830.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,318.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,993.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$14,976.00
|
| Rate for Payer: Networks By Design Commercial |
$12,979.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$16,972.80
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,980.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,980.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$43,910.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906820257
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$39,519.00 |
| Rate for Payer: Adventist Health Commercial |
$8,782.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$24,150.50
|
| Rate for Payer: Cash Price |
$24,150.50
|
| Rate for Payer: Cash Price |
$24,150.50
|
| Rate for Payer: Central Health Plan Commercial |
$35,128.00
|
| Rate for Payer: Cigna of CA HMO |
$28,102.40
|
| Rate for Payer: Cigna of CA PPO |
$32,493.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$37,323.50
|
| Rate for Payer: Global Benefits Group Commercial |
$26,346.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,519.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,287.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,729.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$32,932.50
|
| Rate for Payer: Networks By Design Commercial |
$28,541.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$37,323.50
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,346.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26,346.00
|
| 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: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$23,492.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906820239
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$830.85 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,698.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$12,920.60
|
| Rate for Payer: Cash Price |
$12,920.60
|
| Rate for Payer: Cash Price |
$12,920.60
|
| Rate for Payer: Central Health Plan Commercial |
$18,793.60
|
| Rate for Payer: Cigna of CA HMO |
$15,269.80
|
| Rate for Payer: Cigna of CA PPO |
$17,384.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$19,968.20
|
| Rate for Payer: Global Benefits Group Commercial |
$14,095.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,142.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$830.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,669.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,698.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$17,619.00
|
| Rate for Payer: Networks By Design Commercial |
$15,269.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$19,968.20
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,095.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,095.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$37,324.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,464.80 |
| Max. Negotiated Rate |
$33,591.60 |
| Rate for Payer: Adventist Health Commercial |
$7,464.80
|
| Rate for Payer: Cash Price |
$20,528.20
|
| Rate for Payer: Central Health Plan Commercial |
$29,859.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,929.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,929.60
|
| Rate for Payer: Galaxy Health WC |
$31,725.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22,394.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,591.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,895.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,220.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,103.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,464.80
|
| Rate for Payer: Multiplan Commercial |
$27,993.00
|
| Rate for Payer: Networks By Design Commercial |
$24,260.60
|
| Rate for Payer: Prime Health Services Commercial |
$31,725.40
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$37,324.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$33,591.60 |
| Rate for Payer: Adventist Health Commercial |
$7,464.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$20,528.20
|
| Rate for Payer: Cash Price |
$20,528.20
|
| Rate for Payer: Cash Price |
$20,528.20
|
| Rate for Payer: Central Health Plan Commercial |
$29,859.20
|
| Rate for Payer: Cigna of CA HMO |
$23,887.36
|
| Rate for Payer: Cigna of CA PPO |
$27,619.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$31,725.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22,394.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,591.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,895.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,220.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,464.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$27,993.00
|
| Rate for Payer: Networks By Design Commercial |
$24,260.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$31,725.40
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,394.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,394.40
|
| 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: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$43,910.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906820257
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8,782.00 |
| Max. Negotiated Rate |
$39,519.00 |
| Rate for Payer: Adventist Health Commercial |
$8,782.00
|
| Rate for Payer: Cash Price |
$24,150.50
|
| Rate for Payer: Central Health Plan Commercial |
$35,128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,564.00
|
| Rate for Payer: EPIC Health Plan Senior |
$17,564.00
|
| Rate for Payer: Galaxy Health WC |
$37,323.50
|
| Rate for Payer: Global Benefits Group Commercial |
$26,346.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,519.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,287.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,729.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,180.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.00
|
| Rate for Payer: Multiplan Commercial |
$32,932.50
|
| Rate for Payer: Networks By Design Commercial |
$28,541.50
|
| Rate for Payer: Prime Health Services Commercial |
$37,323.50
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$6,611.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$252.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,636.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,201.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,882.64
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: Cigna of CA HMO |
$4,297.15
|
| Rate for Payer: Cigna of CA PPO |
$4,892.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,619.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,619.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,644.40
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,305.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,092.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,627.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,627.70
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,644.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,966.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,966.60
|
| 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 |
$5,619.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,619.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,619.35
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$7,778.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906820083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,555.60 |
| Max. Negotiated Rate |
$7,000.20 |
| Rate for Payer: Adventist Health Commercial |
$1,555.60
|
| Rate for Payer: Cash Price |
$4,277.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,222.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,111.20
|
| Rate for Payer: Galaxy Health WC |
$6,611.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,000.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,963.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,814.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,555.60
|
| Rate for Payer: Multiplan Commercial |
$5,833.50
|
| Rate for Payer: Networks By Design Commercial |
$5,055.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,611.30
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$6,611.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,322.20 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,644.40
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,518.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,092.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$7,778.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906820083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$252.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,555.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,611.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,277.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,833.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,766.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,568.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,277.90
|
| Rate for Payer: Cash Price |
$4,277.90
|
| Rate for Payer: Cash Price |
$4,277.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,222.40
|
| Rate for Payer: Cigna of CA HMO |
$5,055.70
|
| Rate for Payer: Cigna of CA PPO |
$5,755.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,611.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,611.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,611.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,111.20
|
| Rate for Payer: Galaxy Health WC |
$6,611.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,666.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,000.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,889.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,814.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,555.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,444.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,444.60
|
| Rate for Payer: Multiplan Commercial |
$5,833.50
|
| Rate for Payer: Networks By Design Commercial |
$5,055.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,611.30
|
| Rate for Payer: Riverside University Health System MISP |
$3,111.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,666.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,666.80
|
| 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 |
$6,611.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,611.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,611.30
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
OP
|
$14,422.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$12,979.80 |
| Rate for Payer: Adventist Health Commercial |
$2,884.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Cash Price |
$7,932.10
|
| Rate for Payer: Cash Price |
$7,932.10
|
| Rate for Payer: Cash Price |
$7,932.10
|
| Rate for Payer: Cash Price |
$7,932.10
|
| Rate for Payer: Central Health Plan Commercial |
$11,537.60
|
| Rate for Payer: Cigna of CA HMO |
$9,230.08
|
| Rate for Payer: Cigna of CA PPO |
$10,672.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$12,258.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,653.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,979.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,573.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,619.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,884.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,872.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$10,816.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$9,374.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$12,258.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,645.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,820.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,653.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,211.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,211.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,211.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,211.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS
|
Facility
|
IP
|
$14,422.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
900501751
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,884.40 |
| Max. Negotiated Rate |
$12,979.80 |
| Rate for Payer: Adventist Health Commercial |
$2,884.40
|
| Rate for Payer: Cash Price |
$7,932.10
|
| Rate for Payer: Central Health Plan Commercial |
$11,537.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,768.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,768.80
|
| Rate for Payer: Galaxy Health WC |
$12,258.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,653.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,979.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,619.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,494.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,927.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,884.40
|
| Rate for Payer: Multiplan Commercial |
$10,816.50
|
| Rate for Payer: Networks By Design Commercial |
$9,374.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,258.70
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$419.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.94
|
| Rate for Payer: Blue Shield of California Commercial |
$418.83
|
| Rate for Payer: Blue Shield of California EPN |
$273.93
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC CORPORA CAVERNOSOGRAPHY
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 74445
|
| Hospital Charge Code |
909080040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Senior |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$427.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC CORTISOL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$118.72 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.09
|
| Rate for Payer: Blue Shield of California Commercial |
$77.70
|
| Rate for Payer: Blue Shield of California EPN |
$50.82
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: InnovAge PACE Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.30
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Prime Health Services Medicare |
$17.28
|
| Rate for Payer: Riverside University Health System MISP |
$17.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC CORTISOL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC COUGH ASSIST
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.06
|
| Rate for Payer: Blue Shield of California Commercial |
$302.89
|
| Rate for Payer: Blue Shield of California EPN |
$198.10
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC COUGH ASSIST
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801124
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Adventist Health Commercial |
$99.80
|
| Rate for Payer: Cash Price |
$274.45
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Senior |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,434.42 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$540.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$786.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$627.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$760.55
|
| Rate for Payer: Blue Shield of California Commercial |
$791.25
|
| Rate for Payer: Blue Shield of California EPN |
$516.71
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: Cigna of CA HMO |
$828.80
|
| Rate for Payer: Cigna of CA PPO |
$958.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$594.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$540.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.07
|
| Rate for Payer: EPIC Health Plan Senior |
$540.79
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$886.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,298.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$540.79
|
| Rate for Payer: InnovAge PACE Commercial |
$811.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$540.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$724.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$724.66
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$540.79
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
| Rate for Payer: Prime Health Services Medicare |
$573.24
|
| Rate for Payer: Riverside University Health System MISP |
$594.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$777.00
|
| 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 |
$540.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$594.87
|
| Rate for Payer: Vantage Medical Group Senior |
$540.79
|
|
|
HC COVID19 CONVALESCENT PLASMA
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT C9507
|
| Hospital Charge Code |
900909507
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.00
|
| Rate for Payer: EPIC Health Plan Senior |
$518.00
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
|
|
HC COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.17 |
| Max. Negotiated Rate |
$1,105.20 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$180.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$745.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$594.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$721.20
|
| Rate for Payer: Blue Shield of California Commercial |
$750.31
|
| Rate for Payer: Blue Shield of California EPN |
$489.97
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Central Health Plan Commercial |
$982.40
|
| Rate for Payer: Cigna of CA HMO |
$785.92
|
| Rate for Payer: Cigna of CA PPO |
$908.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,105.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: InnovAge PACE Commercial |
$270.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$819.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$241.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$921.00
|
| Rate for Payer: Networks By Design Commercial |
$798.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$180.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
| Rate for Payer: Prime Health Services Medicare |
$190.98
|
| Rate for Payer: Riverside University Health System MISP |
$198.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$736.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$736.80
|
| 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 |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC COVID19 CONVLESNT PLASMA, DIVIDED
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$1,105.20 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Cash Price |
$675.40
|
| Rate for Payer: Central Health Plan Commercial |
$982.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$491.20
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,105.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$819.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$760.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.60
|
| Rate for Payer: Multiplan Commercial |
$921.00
|
| Rate for Payer: Networks By Design Commercial |
$798.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
|
|
HC COVID 19 IGM IGG
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
900912259
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$54.02
|
| Rate for Payer: Blue Shield of California EPN |
$35.33
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Cash Price |
$48.95
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: Cigna of CA HMO |
$56.96
|
| Rate for Payer: Cigna of CA PPO |
$65.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.42
|
| Rate for Payer: EPIC Health Plan Senior |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.09
|
| Rate for Payer: InnovAge PACE Commercial |
$27.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.09
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
| Rate for Payer: Prime Health Services Medicare |
$19.18
|
| Rate for Payer: Riverside University Health System MISP |
$19.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.65
|
| Rate for Payer: United Healthcare All Other HMO |
$14.65
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18.09
|
|
