|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| 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 |
$2,181.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,424.83
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| 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 |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,785.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,785.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,785.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,785.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| 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 |
$2,181.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,424.83
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| 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 |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,360.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,210.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,464.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,381.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC EPIFIX 2X3
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Blue Shield of California Commercial |
$502.45
|
| Rate for Payer: Blue Shield of California EPN |
$327.60
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: Cigna of CA HMO |
$455.00
|
| Rate for Payer: Cigna of CA PPO |
$455.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$260.00
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.94
|
| Rate for Payer: United Healthcare All Other HMO |
$237.44
|
| Rate for Payer: United Healthcare HMO Rider |
$232.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.88
|
|
|
HC EPIFIX 2X3
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$487.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.75
|
| Rate for Payer: Blue Shield of California Commercial |
$397.15
|
| Rate for Payer: Blue Shield of California EPN |
$259.35
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: Cigna of CA HMO |
$455.00
|
| Rate for Payer: Cigna of CA PPO |
$455.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$552.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$552.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$260.00
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.33
|
| Rate for Payer: InnovAge PACE Commercial |
$325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$455.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| Rate for Payer: Riverside University Health System MISP |
$260.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.94
|
| Rate for Payer: United Healthcare All Other HMO |
$237.44
|
| Rate for Payer: United Healthcare HMO Rider |
$232.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$552.50
|
| Rate for Payer: Vantage Medical Group Senior |
$552.50
|
|
|
HC EP MED TEMP PACING SCREW-IN
|
Facility
|
IP
|
$1,288.00
|
|
| Hospital Charge Code |
906812351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Adventist Health Commercial |
$257.60
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$515.20
|
| Rate for Payer: Galaxy Health WC |
$1,094.80
|
| Rate for Payer: Global Benefits Group Commercial |
$772.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,159.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$859.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$797.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$966.00
|
| Rate for Payer: Networks By Design Commercial |
$837.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,094.80
|
|
|
HC EP MED TEMP PACING SCREW-IN
|
Facility
|
OP
|
$1,288.00
|
|
| Hospital Charge Code |
906812351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Adventist Health Commercial |
$257.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$782.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,094.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$708.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$966.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$623.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$756.44
|
| Rate for Payer: Blue Shield of California Commercial |
$786.97
|
| Rate for Payer: Blue Shield of California EPN |
$513.91
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,030.40
|
| Rate for Payer: Cigna of CA HMO |
$824.32
|
| Rate for Payer: Cigna of CA PPO |
$953.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,094.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,094.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$515.20
|
| Rate for Payer: Galaxy Health WC |
$1,094.80
|
| Rate for Payer: Global Benefits Group Commercial |
$772.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,159.20
|
| Rate for Payer: InnovAge PACE Commercial |
$644.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$859.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$797.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$901.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$901.60
|
| Rate for Payer: Multiplan Commercial |
$966.00
|
| Rate for Payer: Networks By Design Commercial |
$837.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,094.80
|
| Rate for Payer: Riverside University Health System MISP |
$515.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$772.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$772.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.00
|
| Rate for Payer: United Healthcare All Other HMO |
$644.00
|
| Rate for Payer: United Healthcare HMO Rider |
$644.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$644.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,094.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,094.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,094.80
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
OP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$292.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.49
|
| Rate for Payer: Blue Shield of California Commercial |
$293.89
|
| Rate for Payer: Blue Shield of California EPN |
$191.92
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: InnovAge PACE Commercial |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.70
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Riverside University Health System MISP |
$192.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.50
|
| Rate for Payer: United Healthcare All Other HMO |
$240.50
|
| Rate for Payer: United Healthcare HMO Rider |
$240.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.85
|
| Rate for Payer: Vantage Medical Group Senior |
$408.85
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
IP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC EP RF BIO WEB EZ STEER THERMOC
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.60 |
| Max. Negotiated Rate |
$3,521.70 |
| Rate for Payer: Adventist Health Commercial |
$782.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,024.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,972.15
|
| Rate for Payer: Cash Price |
$1,760.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,130.40
|
| Rate for Payer: Cigna of CA HMO |
$2,739.10
|
| Rate for Payer: Cigna of CA PPO |
$2,739.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,565.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,565.20
|
| Rate for Payer: Galaxy Health WC |
$3,326.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,347.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,521.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,609.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,490.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,422.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$2,934.75
|
| Rate for Payer: Networks By Design Commercial |
$1,956.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,326.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,468.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,429.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,398.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,281.51
|
|
|
HC EP RF BIO WEB EZ STEER THERMOC
|
Facility
|
OP
|
$3,913.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.60 |
| Max. Negotiated Rate |
$3,521.70 |
| Rate for Payer: Adventist Health Commercial |
$782.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,326.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,152.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,934.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,786.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,166.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,024.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,972.15
|
| Rate for Payer: Cash Price |
$1,760.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,130.40
|
| Rate for Payer: Cigna of CA HMO |
$2,739.10
|
| Rate for Payer: Cigna of CA PPO |
$2,739.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,326.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,326.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,326.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,565.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,565.20
|
| Rate for Payer: Galaxy Health WC |
$3,326.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,347.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,521.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,956.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,609.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,490.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,422.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,739.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,739.10
|
| Rate for Payer: Multiplan Commercial |
$2,934.75
|
| Rate for Payer: Networks By Design Commercial |
$1,956.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,326.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,565.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,347.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,347.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,468.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,429.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,398.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,281.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,326.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,326.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,326.05
|
|
|
HC EP RF CRYO ARCTIC FRONT ADVANCE
|
Facility
|
OP
|
$11,625.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.00 |
| Max. Negotiated Rate |
$10,462.50 |
| Rate for Payer: Adventist Health Commercial |
$2,325.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,881.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,393.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,718.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,307.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,436.76
|
| Rate for Payer: Blue Shield of California Commercial |
$8,986.12
|
| Rate for Payer: Blue Shield of California EPN |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,231.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,300.00
|
| Rate for Payer: Cigna of CA HMO |
$8,137.50
|
| Rate for Payer: Cigna of CA PPO |
$8,137.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,881.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,881.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,881.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,650.00
|
| Rate for Payer: Galaxy Health WC |
$9,881.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,462.50
|
| Rate for Payer: InnovAge PACE Commercial |
$5,812.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,753.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,429.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,195.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,325.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,137.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,137.50
|
| Rate for Payer: Multiplan Commercial |
$8,718.75
|
| Rate for Payer: Networks By Design Commercial |
$5,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,881.25
|
| Rate for Payer: Riverside University Health System MISP |
$4,650.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,975.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,975.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,362.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4,246.61
|
| Rate for Payer: United Healthcare HMO Rider |
$4,154.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,807.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,881.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,881.25
|
| Rate for Payer: Vantage Medical Group Senior |
$9,881.25
|
|
|
HC EP RF CRYO ARCTIC FRONT ADVANCE
|
Facility
|
IP
|
$11,625.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.00 |
| Max. Negotiated Rate |
$10,462.50 |
| Rate for Payer: Adventist Health Commercial |
$2,325.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,986.12
|
| Rate for Payer: Blue Shield of California EPN |
$5,859.00
|
| Rate for Payer: Cash Price |
$5,231.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,300.00
|
| Rate for Payer: Cigna of CA HMO |
$8,137.50
|
| Rate for Payer: Cigna of CA PPO |
$8,137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,650.00
|
| Rate for Payer: Galaxy Health WC |
$9,881.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,975.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,462.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,753.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,429.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,195.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,325.00
|
| Rate for Payer: Multiplan Commercial |
$8,718.75
|
| Rate for Payer: Networks By Design Commercial |
$5,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,881.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,362.86
|
| Rate for Payer: United Healthcare All Other HMO |
$4,246.61
|
| Rate for Payer: United Healthcare HMO Rider |
$4,154.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,807.19
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
IP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
OP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$253.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.49
|
| Rate for Payer: Blue Shield of California Commercial |
$255.40
|
| Rate for Payer: Blue Shield of California EPN |
$166.78
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: Cigna of CA HMO |
$267.52
|
| Rate for Payer: Cigna of CA PPO |
$309.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$355.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: InnovAge PACE Commercial |
$209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$292.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$292.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Riverside University Health System MISP |
$167.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$209.00
|
| Rate for Payer: United Healthcare HMO Rider |
$209.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$355.30
|
| Rate for Payer: Vantage Medical Group Senior |
$355.30
|
|
|
HC EP RF STJ ENSIT VELOCITY PATCH
|
Facility
|
IP
|
$3,347.00
|
|
|
Service Code
|
CPT C1732
|
| Hospital Charge Code |
906812548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.40 |
| Max. Negotiated Rate |
$3,012.30 |
| Rate for Payer: Adventist Health Commercial |
$669.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,587.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,686.89
|
| Rate for Payer: Cash Price |
$1,506.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,677.60
|
| Rate for Payer: Cigna of CA HMO |
$2,342.90
|
| Rate for Payer: Cigna of CA PPO |
$2,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,338.80
|
| Rate for Payer: Galaxy Health WC |
$2,844.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,012.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,232.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,275.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,071.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.40
|
| Rate for Payer: Multiplan Commercial |
$2,510.25
|
| Rate for Payer: Networks By Design Commercial |
$1,673.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,844.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,256.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,222.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,196.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.14
|
|
|
HC EP RF STJ ENSIT VELOCITY PATCH
|
Facility
|
OP
|
$3,347.00
|
|
|
Service Code
|
CPT C1732
|
| Hospital Charge Code |
906812548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.40 |
| Max. Negotiated Rate |
$3,012.30 |
| Rate for Payer: Adventist Health Commercial |
$669.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,844.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,840.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,510.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,528.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,853.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,587.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,686.89
|
| Rate for Payer: Cash Price |
$1,506.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,677.60
|
| Rate for Payer: Cigna of CA HMO |
$2,342.90
|
| Rate for Payer: Cigna of CA PPO |
$2,342.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,844.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,844.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,844.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,338.80
|
| Rate for Payer: Galaxy Health WC |
$2,844.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,008.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,012.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,673.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,232.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,275.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,071.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,342.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,342.90
|
| Rate for Payer: Multiplan Commercial |
$2,510.25
|
| Rate for Payer: Networks By Design Commercial |
$1,673.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,844.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,338.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,008.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,256.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,222.66
|
| Rate for Payer: United Healthcare HMO Rider |
$1,196.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,096.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,844.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,844.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,844.95
|
|
|
HC EP RF ST J FLEXABILITY D-F
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.00
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
|
|
HC EP RF ST J FLEXABILITY D-F
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,505.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,997.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,422.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,520.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,645.88
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,052.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,887.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,650.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
|
HC EP RF ST J FLEXABILITY F-J
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
CPT C2630
|
| Hospital Charge Code |
906812638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$3,712.50 |
| Rate for Payer: Adventist Health Commercial |
$825.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,505.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,268.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,093.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,997.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,422.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,520.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,645.88
|
| Rate for Payer: Cash Price |
$1,856.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,640.00
|
| Rate for Payer: Cigna of CA PPO |
$3,052.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,506.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,650.00
|
| Rate for Payer: Galaxy Health WC |
$3,506.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,712.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,751.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,571.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,553.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,887.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,887.50
|
| Rate for Payer: Multiplan Commercial |
$3,093.75
|
| Rate for Payer: Networks By Design Commercial |
$2,681.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,506.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,650.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,475.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,062.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,506.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,506.25
|
|
