|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Blue Shield of California Commercial |
$581.25
|
| Rate for Payer: Blue Shield of California EPN |
$413.85
|
| Rate for Payer: Cash Price |
$348.75
|
| Rate for Payer: Central Health Plan Commercial |
$620.00
|
| Rate for Payer: Cigna of CA HMO |
$542.50
|
| Rate for Payer: Cigna of CA PPO |
$542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.00
|
| Rate for Payer: Galaxy Health WC |
$658.75
|
| Rate for Payer: Global Benefits Group Commercial |
$465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$697.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$581.25
|
| Rate for Payer: Networks By Design Commercial |
$387.50
|
| Rate for Payer: Prime Health Services Commercial |
$658.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.64
|
| Rate for Payer: United Healthcare All Other HMO |
$285.82
|
| Rate for Payer: United Healthcare HMO Rider |
$279.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.75
|
|
|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$658.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$375.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.87
|
| Rate for Payer: Blue Distinction Transplant |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$487.48
|
| Rate for Payer: Blue Shield of California EPN |
$378.98
|
| Rate for Payer: Cash Price |
$348.75
|
| Rate for Payer: Cash Price |
$348.75
|
| Rate for Payer: Central Health Plan Commercial |
$620.00
|
| Rate for Payer: Cigna of CA HMO |
$542.50
|
| Rate for Payer: Cigna of CA PPO |
$542.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$658.75
|
| Rate for Payer: Dignity Health Media |
$658.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$658.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.00
|
| Rate for Payer: Galaxy Health WC |
$658.75
|
| Rate for Payer: Global Benefits Group Commercial |
$465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$697.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$581.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$581.25
|
| Rate for Payer: Networks By Design Commercial |
$387.50
|
| Rate for Payer: Prime Health Services Commercial |
$658.75
|
| Rate for Payer: Riverside University Health System MISP |
$310.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.50
|
| Rate for Payer: United Healthcare All Other HMO |
$387.50
|
| Rate for Payer: United Healthcare HMO Rider |
$387.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$658.75
|
| Rate for Payer: Vantage Medical Group Senior |
$658.75
|
|
|
HC CORD NEOX RT 3.0X2.0CM
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| 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 |
$357.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.02
|
| Rate for Payer: Blue Distinction Transplant |
$390.00
|
| Rate for Payer: Blue Shield of California Commercial |
$408.85
|
| Rate for Payer: Blue Shield of California EPN |
$317.85
|
| 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 Media |
$552.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$487.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.93
|
| 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: 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: 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 |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO |
$325.00
|
| Rate for Payer: United Healthcare HMO Rider |
$325.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$552.50
|
| Rate for Payer: Vantage Medical Group Senior |
$552.50
|
|
|
HC CORD NEOX RT 3.0X2.0CM
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Blue Shield of California Commercial |
$487.50
|
| Rate for Payer: Blue Shield of California EPN |
$347.10
|
| 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 Transplant |
$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: 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 |
$245.44
|
| Rate for Payer: United Healthcare All Other HMO |
$239.72
|
| Rate for Payer: United Healthcare HMO Rider |
$234.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.50
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$389.70 |
| Rate for Payer: Blue Shield of California Commercial |
$324.75
|
| Rate for Payer: Blue Shield of California EPN |
$231.22
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Central Health Plan Commercial |
$346.40
|
| Rate for Payer: Cigna of CA HMO |
$303.10
|
| Rate for Payer: Cigna of CA PPO |
$303.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$173.20
|
| Rate for Payer: Galaxy Health WC |
$368.05
|
| Rate for Payer: Global Benefits Group Commercial |
$259.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$389.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.60
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| Rate for Payer: Networks By Design Commercial |
$216.50
|
| Rate for Payer: Prime Health Services Commercial |
$368.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.50
|
| Rate for Payer: United Healthcare All Other HMO |
$159.69
|
| Rate for Payer: United Healthcare HMO Rider |
$156.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.89
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.82
|
| Rate for Payer: Blue Distinction Transplant |
$259.80
|
| Rate for Payer: Blue Shield of California Commercial |
$272.36
|
| Rate for Payer: Blue Shield of California EPN |
$211.74
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Central Health Plan Commercial |
$346.40
|
| Rate for Payer: Cigna of CA HMO |
$303.10
|
| Rate for Payer: Cigna of CA PPO |
$303.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.05
|
| Rate for Payer: Dignity Health Media |
$368.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$173.20
|
| Rate for Payer: Galaxy Health WC |
$368.05
|
| Rate for Payer: Global Benefits Group Commercial |
$259.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$389.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$324.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.60
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| Rate for Payer: Networks By Design Commercial |
$216.50
|
| Rate for Payer: Prime Health Services Commercial |
$368.05
|
| Rate for Payer: Riverside University Health System MISP |
$173.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$216.50
|
| Rate for Payer: United Healthcare HMO Rider |
$216.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.05
|
| Rate for Payer: Vantage Medical Group Senior |
$368.05
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Blue Shield of California Commercial |
$243.75
|
| Rate for Payer: Blue Shield of California EPN |
$173.55
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.86
|
| Rate for Payer: United Healthcare HMO Rider |
$117.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.25
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.01
|
| Rate for Payer: Blue Distinction Transplant |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.42
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Media |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$243.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Riverside University Health System MISP |
$130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,123.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$567.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.40
|
| Rate for Payer: Blue Shield of California EPN |
$462.10
|
| Rate for Payer: Caremore Medicare Advantage |
$400.82
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Media |
$400.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.82
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$657.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$661.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: InnovAge PACE Commercial |
$601.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Prime Health Services Medicare |
$424.87
|
| Rate for Payer: Riverside University Health System MISP |
$440.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,151.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,201.60
|
| Rate for Payer: Cigna of CA PPO |
$3,886.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$4,464.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,726.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,939.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,342.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,669.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,939.00
|
| Rate for Payer: Networks By Design Commercial |
$3,413.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,464.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,050.40 |
| Max. Negotiated Rate |
$4,726.80 |
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,100.80
|
| Rate for Payer: Galaxy Health WC |
$4,464.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,726.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,503.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.40
|
| Rate for Payer: Multiplan Commercial |
$3,939.00
|
| Rate for Payer: Networks By Design Commercial |
$3,413.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,464.20
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$17,317.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,463.40 |
| Max. Negotiated Rate |
$15,585.30 |
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Central Health Plan Commercial |
$13,853.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,926.80
|
| Rate for Payer: Galaxy Health WC |
$14,719.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,390.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,585.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,597.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,463.40
|
| Rate for Payer: Multiplan Commercial |
$12,987.75
|
| Rate for Payer: Networks By Design Commercial |
$11,256.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,719.45
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$17,317.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,496.54 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,044.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,390.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Central Health Plan Commercial |
$13,853.60
|
| Rate for Payer: Cigna of CA PPO |
$12,814.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$14,719.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,390.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,585.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,987.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,496.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,463.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$12,987.75
|
| Rate for Payer: Networks By Design Commercial |
$11,256.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,719.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,390.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$17,317.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906820059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,463.40 |
| Max. Negotiated Rate |
$15,585.30 |
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Central Health Plan Commercial |
$13,853.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,926.80
|
| Rate for Payer: Galaxy Health WC |
$14,719.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,390.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,585.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,597.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,463.40
|
| Rate for Payer: Multiplan Commercial |
$12,987.75
|
| Rate for Payer: Networks By Design Commercial |
$11,256.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,719.45
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$17,317.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906820059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,496.54 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,044.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,390.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Cash Price |
$7,792.65
|
| Rate for Payer: Central Health Plan Commercial |
$13,853.60
|
| Rate for Payer: Cigna of CA PPO |
$12,814.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$14,719.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,390.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,585.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,987.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,550.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,496.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,463.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$12,987.75
|
| Rate for Payer: Networks By Design Commercial |
$11,256.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,719.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,390.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
OP
|
$14,820.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,747.03 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,452.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,892.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,856.00
|
| Rate for Payer: Cigna of CA PPO |
$10,966.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$12,597.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,892.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,338.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,115.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,747.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,964.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$11,115.00
|
| Rate for Payer: Networks By Design Commercial |
$9,633.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,597.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,892.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
OP
|
$14,820.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906820060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,747.03 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,452.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,892.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,856.00
|
| Rate for Payer: Cigna of CA PPO |
$10,966.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$12,597.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,892.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,338.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,115.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,747.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,964.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$11,115.00
|
| Rate for Payer: Networks By Design Commercial |
$9,633.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,597.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,892.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
IP
|
$14,820.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,964.00 |
| Max. Negotiated Rate |
$13,338.00 |
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,856.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,928.00
|
| Rate for Payer: Galaxy Health WC |
$12,597.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,892.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,338.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,646.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,964.00
|
| Rate for Payer: Multiplan Commercial |
$11,115.00
|
| Rate for Payer: Networks By Design Commercial |
$9,633.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,597.00
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
IP
|
$14,820.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906820060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,964.00 |
| Max. Negotiated Rate |
$13,338.00 |
| Rate for Payer: Cash Price |
$6,669.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,856.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,928.00
|
| Rate for Payer: Galaxy Health WC |
$12,597.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,892.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,338.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,646.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,964.00
|
| Rate for Payer: Multiplan Commercial |
$11,115.00
|
| Rate for Payer: Networks By Design Commercial |
$9,633.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,597.00
|
|
|
HC CORONARY CTA W/MORPH W/O CCS
|
Facility
|
IP
|
$5,396.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,079.20 |
| Max. Negotiated Rate |
$4,856.40 |
| Rate for Payer: Cash Price |
$2,428.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,158.40
|
| Rate for Payer: Galaxy Health WC |
$4,586.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,237.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,856.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,599.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,055.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.20
|
| Rate for Payer: Multiplan Commercial |
$4,047.00
|
| Rate for Payer: Networks By Design Commercial |
$3,507.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,586.60
|
|
|
HC CORONARY CTA W/MORPH W/O CCS
|
Facility
|
OP
|
$3,786.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$229.56 |
| Max. Negotiated Rate |
$3,407.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,507.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,236.77
|
| Rate for Payer: Blue Distinction Transplant |
$2,271.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,339.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,840.00
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$1,703.70
|
| Rate for Payer: Cash Price |
$1,703.70
|
| Rate for Payer: Center for Health Promotion Commercial |
$255.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,028.80
|
| Rate for Payer: Cigna of CA HMO |
$2,423.04
|
| Rate for Payer: Cigna of CA PPO |
$2,801.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$3,218.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,271.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,407.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,839.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,525.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$2,839.50
|
| Rate for Payer: Networks By Design Commercial |
$2,460.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,218.10
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,271.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,271.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Other HMO |
$669.92
|
| Rate for Payer: United Healthcare HMO Rider |
$669.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
OP
|
$9,892.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,978.40 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,300.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,408.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,440.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,440.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,935.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Cash Price |
$4,451.40
|
| Rate for Payer: Cash Price |
$4,451.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,913.60
|
| Rate for Payer: Cigna of CA PPO |
$7,320.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,408.20
|
| Rate for Payer: Dignity Health Media |
$8,408.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,408.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,956.80
|
| Rate for Payer: Galaxy Health WC |
$8,408.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,902.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,419.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,462.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,978.40
|
| Rate for Payer: Multiplan Commercial |
$7,419.00
|
| Rate for Payer: Networks By Design Commercial |
$6,429.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,408.20
|
| Rate for Payer: Riverside University Health System MISP |
$3,956.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,935.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,935.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,408.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8,408.20
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$9,892.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,978.40 |
| Max. Negotiated Rate |
$8,902.80 |
| Rate for Payer: Cash Price |
$4,451.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.80
|
| Rate for Payer: Galaxy Health WC |
$8,408.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,902.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,768.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,978.40
|
| Rate for Payer: Multiplan Commercial |
$7,419.00
|
| Rate for Payer: Networks By Design Commercial |
$6,429.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,408.20
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$9,892.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906820240
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,978.40 |
| Max. Negotiated Rate |
$8,902.80 |
| Rate for Payer: Cash Price |
$4,451.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.80
|
| Rate for Payer: Galaxy Health WC |
$8,408.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,935.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,902.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,768.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,978.40
|
| Rate for Payer: Multiplan Commercial |
$7,419.00
|
| Rate for Payer: Networks By Design Commercial |
$6,429.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,408.20
|
|
