|
HC IND COOK FLEXOR CHECKFLO
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.57
|
| Rate for Payer: Blue Shield of California Commercial |
$318.94
|
| Rate for Payer: Blue Shield of California EPN |
$208.28
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$334.08
|
| Rate for Payer: Cigna of CA PPO |
$386.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: InnovAge PACE Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Riverside University Health System MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC IND COOK RAABE FLEXOR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC IND COOK RAABE FLEXOR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC INDIV BRIEF THERAPY
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
907804005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$204.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.63
|
| Rate for Payer: Blue Shield of California Commercial |
$238.90
|
| Rate for Payer: Blue Shield of California EPN |
$156.01
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Senior |
$204.15
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.15
|
| Rate for Payer: InnovAge PACE Commercial |
$306.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.56
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$204.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Prime Health Services Medicare |
$216.40
|
| Rate for Payer: Riverside University Health System MISP |
$224.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$204.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.56
|
| Rate for Payer: Vantage Medical Group Senior |
$204.15
|
|
|
HC INDIV THERAPY
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804007
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC INDIV THERAPY
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804007
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.63
|
| Rate for Payer: Blue Shield of California Commercial |
$238.90
|
| Rate for Payer: Blue Shield of California EPN |
$156.01
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Central Health Plan Commercial |
$312.80
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.90
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$293.25
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC INDR ARGON PERCUTANEOUS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
|
|
HC INDR ARGON PERCUTANEOUS
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812428
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.11
|
| Rate for Payer: Blue Shield of California Commercial |
$158.25
|
| Rate for Payer: Blue Shield of California EPN |
$103.34
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: InnovAge PACE Commercial |
$129.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Riverside University Health System MISP |
$103.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$129.50
|
| Rate for Payer: United Healthcare HMO Rider |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC INDR ARROW FLEX 24 CM
|
Facility
|
IP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
|
|
HC INDR ARROW FLEX 24 CM
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.94
|
| Rate for Payer: Blue Shield of California Commercial |
$43.64
|
| Rate for Payer: Blue Shield of California EPN |
$28.50
|
| Rate for Payer: Cash Price |
$39.28
|
| Rate for Payer: Central Health Plan Commercial |
$57.14
|
| Rate for Payer: Cigna of CA HMO |
$45.71
|
| Rate for Payer: Cigna of CA PPO |
$52.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.57
|
| Rate for Payer: EPIC Health Plan Senior |
$28.57
|
| Rate for Payer: Galaxy Health WC |
$60.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.28
|
| Rate for Payer: InnovAge PACE Commercial |
$35.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.99
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.71
|
| Rate for Payer: Riverside University Health System MISP |
$28.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.71
|
| Rate for Payer: United Healthcare All Other HMO |
$35.71
|
| Rate for Payer: United Healthcare HMO Rider |
$35.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.71
|
| Rate for Payer: Vantage Medical Group Senior |
$60.71
|
|
|
HC INDR BARD CHANNEL STEERABLE 8F
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
CPT C1766
|
| Hospital Charge Code |
906812348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,894.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,716.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,510.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,832.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,906.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.88
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Cigna of CA HMO |
$1,996.80
|
| Rate for Payer: Cigna of CA PPO |
$2,308.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,652.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,808.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,184.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,248.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,872.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,652.00
|
|
|
HC INDR BARD CHANNEL STEERABLE 8F
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
CPT C1766
|
| Hospital Charge Code |
906812348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,808.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
|
|
HC INDR BIO/WEB PREFACE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC INDR BIO/WEB PREFACE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$256.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.68
|
| Rate for Payer: Blue Shield of California Commercial |
$323.22
|
| Rate for Payer: Blue Shield of California EPN |
$211.07
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: InnovAge PACE Commercial |
$264.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Riverside University Health System MISP |
$211.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC INDR BIO WEB PREFACE 8FR
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$488.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$389.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$472.78
|
| Rate for Payer: Blue Shield of California Commercial |
$491.86
|
| Rate for Payer: Blue Shield of California EPN |
$321.19
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA HMO |
$515.20
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: InnovAge PACE Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$563.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$563.50
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Riverside University Health System MISP |
$322.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC INDR BIO WEB PREFACE 8FR
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Cash Price |
$442.75
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Senior |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC INDR COOK ANSEL #1 FLEXOR 12FR
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.44
|
| Rate for Payer: Blue Shield of California Commercial |
$248.07
|
| Rate for Payer: Blue Shield of California EPN |
$161.99
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$259.84
|
| Rate for Payer: Cigna of CA PPO |
$300.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: InnovAge PACE Commercial |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Riverside University Health System MISP |
$162.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC INDR COOK ANSEL #1 FLEXOR 12FR
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC INDR COOK ANSEL #1 FLEXOR 9FR
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: EPIC Health Plan Senior |
$150.80
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
|
|
HC INDR COOK ANSEL #1 FLEXOR 9FR
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.41
|
| Rate for Payer: Blue Shield of California Commercial |
$230.35
|
| Rate for Payer: Blue Shield of California EPN |
$150.42
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: Cigna of CA HMO |
$241.28
|
| Rate for Payer: Cigna of CA PPO |
$278.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: EPIC Health Plan Senior |
$150.80
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: InnovAge PACE Commercial |
$188.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.90
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
| Rate for Payer: Riverside University Health System MISP |
$150.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.50
|
| Rate for Payer: United Healthcare All Other HMO |
$188.50
|
| Rate for Payer: United Healthcare HMO Rider |
$188.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.45
|
| Rate for Payer: Vantage Medical Group Senior |
$320.45
|
|
|
HC INDR COOK FLEXOR SHUTTLE
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC INDR COOK FLEXOR SHUTTLE
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812585
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Blue Shield of California Commercial |
$448.34
|
| Rate for Payer: Blue Shield of California EPN |
$292.32
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$406.00
|
| Rate for Payer: Cigna of CA PPO |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$290.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.67
|
| Rate for Payer: United Healthcare All Other HMO |
$211.87
|
| Rate for Payer: United Healthcare HMO Rider |
$207.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$189.95
|
|
|
HC INDR COOK KELLER-TIMMERMAN
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Adventist Health Commercial |
$309.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$938.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$850.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,159.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$748.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$907.97
|
| Rate for Payer: Blue Shield of California Commercial |
$944.61
|
| Rate for Payer: Blue Shield of California EPN |
$616.85
|
| Rate for Payer: Cash Price |
$850.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,236.80
|
| Rate for Payer: Cigna of CA HMO |
$989.44
|
| Rate for Payer: Cigna of CA PPO |
$1,144.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,314.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,314.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$618.40
|
| Rate for Payer: Galaxy Health WC |
$1,314.10
|
| Rate for Payer: Global Benefits Group Commercial |
$927.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,391.40
|
| Rate for Payer: InnovAge PACE Commercial |
$773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,082.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,082.20
|
| Rate for Payer: Multiplan Commercial |
$1,159.50
|
| Rate for Payer: Networks By Design Commercial |
$1,004.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
| Rate for Payer: Riverside University Health System MISP |
$618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$927.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$927.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$773.00
|
| Rate for Payer: United Healthcare HMO Rider |
$773.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,314.10
|
|
|
HC INDR COOK KELLER-TIMMERMAN
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Adventist Health Commercial |
$309.20
|
| Rate for Payer: Cash Price |
$850.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,236.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$618.40
|
| Rate for Payer: Galaxy Health WC |
$1,314.10
|
| Rate for Payer: Global Benefits Group Commercial |
$927.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,391.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.20
|
| Rate for Payer: Multiplan Commercial |
$1,159.50
|
| Rate for Payer: Networks By Design Commercial |
$1,004.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
|
