|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$802.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.06
|
| Rate for Payer: Blue Shield of California EPN |
$388.76
|
| Rate for Payer: Caremore Medicare Advantage |
$802.53
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,324.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: InnovAge PACE Commercial |
$1,203.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Medicare |
$850.68
|
| Rate for Payer: Riverside University Health System MISP |
$882.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$802.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.06
|
| Rate for Payer: Blue Shield of California EPN |
$388.76
|
| Rate for Payer: Caremore Medicare Advantage |
$802.53
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,324.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: InnovAge PACE Commercial |
$1,203.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Medicare |
$850.68
|
| Rate for Payer: Riverside University Health System MISP |
$882.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$802.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.06
|
| Rate for Payer: Blue Shield of California EPN |
$388.76
|
| Rate for Payer: Caremore Medicare Advantage |
$802.53
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,324.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: InnovAge PACE Commercial |
$1,203.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Medicare |
$850.68
|
| Rate for Payer: Riverside University Health System MISP |
$882.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$802.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$500.06
|
| Rate for Payer: Blue Shield of California EPN |
$388.76
|
| Rate for Payer: Caremore Medicare Advantage |
$802.53
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,324.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: InnovAge PACE Commercial |
$1,203.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Medicare |
$850.68
|
| Rate for Payer: Riverside University Health System MISP |
$882.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
OP
|
$6,020.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.89 |
| Max. Negotiated Rate |
$5,418.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$503.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,116.77
|
| Rate for Payer: Blue Distinction Transplant |
$3,612.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,720.36
|
| Rate for Payer: Blue Shield of California EPN |
$2,925.72
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$2,709.00
|
| Rate for Payer: Cash Price |
$2,709.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,816.00
|
| Rate for Payer: Cigna of CA HMO |
$3,852.80
|
| Rate for Payer: Cigna of CA PPO |
$4,454.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$5,117.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,612.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,418.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,515.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,015.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$4,515.00
|
| Rate for Payer: Networks By Design Commercial |
$3,913.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,117.00
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,612.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
IP
|
$6,020.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,204.00 |
| Max. Negotiated Rate |
$5,418.00 |
| Rate for Payer: Cash Price |
$2,709.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,408.00
|
| Rate for Payer: Galaxy Health WC |
$5,117.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,612.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,015.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,293.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$4,515.00
|
| Rate for Payer: Networks By Design Commercial |
$3,913.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,117.00
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
IP
|
$8,766.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,753.20 |
| Max. Negotiated Rate |
$7,889.40 |
| Rate for Payer: Cash Price |
$3,944.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,012.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,506.40
|
| Rate for Payer: Galaxy Health WC |
$7,451.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,259.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,889.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,846.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,339.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,753.20
|
| Rate for Payer: Multiplan Commercial |
$6,574.50
|
| Rate for Payer: Networks By Design Commercial |
$5,697.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,451.10
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
OP
|
$8,766.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.21 |
| Max. Negotiated Rate |
$7,889.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$495.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,625.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,982.35
|
| Rate for Payer: Blue Distinction Transplant |
$5,259.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,417.39
|
| Rate for Payer: Blue Shield of California EPN |
$4,260.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$3,944.70
|
| Rate for Payer: Cash Price |
$3,944.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,012.80
|
| Rate for Payer: Cigna of CA HMO |
$5,610.24
|
| Rate for Payer: Cigna of CA PPO |
$6,486.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$7,451.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,259.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,889.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,574.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,846.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,753.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$6,574.50
|
| Rate for Payer: Networks By Design Commercial |
$5,697.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,451.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,259.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,259.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC DISK ASPIRATION
|
Facility
|
IP
|
$16,121.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,224.20 |
| Max. Negotiated Rate |
$14,508.90 |
| Rate for Payer: Cash Price |
$7,254.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.40
|
| Rate for Payer: Galaxy Health WC |
$13,702.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,142.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.20
|
| Rate for Payer: Multiplan Commercial |
$12,090.75
|
| Rate for Payer: Networks By Design Commercial |
$10,478.65
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.85
|
|
|
HC DISK ASPIRATION
|
Facility
|
OP
|
$16,121.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,414.74 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| 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 |
$9,672.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$7,254.45
|
| Rate for Payer: Cash Price |
$7,254.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,896.80
|
| Rate for Payer: Cigna of CA PPO |
$11,929.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$13,702.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,508.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,090.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,224.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$12,090.75
|
| Rate for Payer: Networks By Design Commercial |
$10,478.65
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| 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 |
$390.60
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: Cigna of CA PPO |
$481.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$488.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$325.50
|
| Rate for Payer: United Healthcare All Other HMO |
$325.50
|
| Rate for Payer: United Healthcare HMO Rider |
$325.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| 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 |
$390.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: Cigna of CA PPO |
$481.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$488.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$698.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| 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 |
$390.60
|
| Rate for Payer: Blue Shield of California Commercial |
$409.48
|
| Rate for Payer: Blue Shield of California EPN |
$318.34
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$481.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$488.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$698.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$325.50
|
| Rate for Payer: United Healthcare All Other HMO |
$325.50
|
| Rate for Payer: United Healthcare HMO Rider |
$325.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| 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 |
$390.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: Cigna of CA PPO |
$481.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$488.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$698.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC DLTN URTHRL STRCTR MALE; INITIAL
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
900501600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC DLTN URTHRL STRCTR MALE; INITIAL
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
900501600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Caremore Medicare Advantage |
$308.79
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Central Health Plan Commercial |
$636.00
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$715.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: InnovAge PACE Commercial |
$463.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Prime Health Services Medicare |
$327.32
|
| Rate for Payer: Riverside University Health System MISP |
$339.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$397.50
|
| Rate for Payer: United Healthcare All Other HMO |
$397.50
|
| Rate for Payer: United Healthcare HMO Rider |
$397.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$397.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
IP
|
$64.29
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Central Health Plan Commercial |
$51.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: Galaxy Health WC |
$54.65
|
| Rate for Payer: Global Benefits Group Commercial |
$38.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$48.22
|
| Rate for Payer: Networks By Design Commercial |
$41.79
|
| Rate for Payer: Prime Health Services Commercial |
$54.65
|
|
