|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
OP
|
$15,177.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906811443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$930.83 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,035.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Central Health Plan Commercial |
$12,141.60
|
| Rate for Payer: Cigna of CA HMO |
$9,865.05
|
| Rate for Payer: Cigna of CA PPO |
$11,230.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$12,900.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,659.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$930.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,123.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,035.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$11,382.75
|
| Rate for Payer: Networks By Design Commercial |
$9,865.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$12,900.45
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
IP
|
$36,885.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,377.00 |
| Max. Negotiated Rate |
$33,196.50 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Central Health Plan Commercial |
$29,508.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,754.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,754.00
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,196.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,831.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,377.00
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
OP
|
$36,885.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Central Health Plan Commercial |
$29,508.00
|
| Rate for Payer: Cigna of CA HMO |
$23,606.40
|
| Rate for Payer: Cigna of CA PPO |
$27,294.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,196.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,377.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,131.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,131.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
OP
|
$31,352.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$6,270.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$17,243.60
|
| Rate for Payer: Cash Price |
$17,243.60
|
| Rate for Payer: Cash Price |
$17,243.60
|
| Rate for Payer: Central Health Plan Commercial |
$25,081.60
|
| Rate for Payer: Cigna of CA HMO |
$20,065.28
|
| Rate for Payer: Cigna of CA PPO |
$23,200.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$26,649.20
|
| Rate for Payer: Global Benefits Group Commercial |
$18,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,216.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,911.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,945.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$23,514.00
|
| Rate for Payer: Networks By Design Commercial |
$20,378.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Prime Health Services Commercial |
$26,649.20
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
IP
|
$31,352.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,270.40 |
| Max. Negotiated Rate |
$28,216.80 |
| Rate for Payer: Adventist Health Commercial |
$6,270.40
|
| Rate for Payer: Cash Price |
$17,243.60
|
| Rate for Payer: Central Health Plan Commercial |
$25,081.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,540.80
|
| Rate for Payer: Galaxy Health WC |
$26,649.20
|
| Rate for Payer: Global Benefits Group Commercial |
$18,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,216.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,911.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,945.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,406.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.40
|
| Rate for Payer: Multiplan Commercial |
$23,514.00
|
| Rate for Payer: Networks By Design Commercial |
$20,378.80
|
| Rate for Payer: Prime Health Services Commercial |
$26,649.20
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
OP
|
$35,128.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$31,615.20 |
| Rate for Payer: Adventist Health Commercial |
$7,025.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21,333.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,320.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26,346.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Central Health Plan Commercial |
$28,102.40
|
| Rate for Payer: Cigna of CA HMO |
$22,481.92
|
| Rate for Payer: Cigna of CA PPO |
$25,994.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,858.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29,858.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,051.20
|
| Rate for Payer: Galaxy Health WC |
$29,858.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21,076.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,615.20
|
| Rate for Payer: InnovAge PACE Commercial |
$17,564.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,430.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,383.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,744.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,025.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,589.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,589.60
|
| Rate for Payer: Multiplan Commercial |
$26,346.00
|
| Rate for Payer: Networks By Design Commercial |
$22,833.20
|
| Rate for Payer: Prime Health Services Commercial |
$29,858.80
|
| Rate for Payer: Riverside University Health System MISP |
$14,051.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,076.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,076.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,858.80
|
| Rate for Payer: Vantage Medical Group Senior |
$29,858.80
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
OP
|
$29,859.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$26,873.10 |
| Rate for Payer: Adventist Health Commercial |
$5,971.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18,133.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,380.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,422.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,394.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$16,422.45
|
| Rate for Payer: Cash Price |
$16,422.45
|
| Rate for Payer: Central Health Plan Commercial |
$23,887.20
|
| Rate for Payer: Cigna of CA HMO |
$19,109.76
|
| Rate for Payer: Cigna of CA PPO |
$22,095.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,380.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,380.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,380.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,943.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,943.60
|
| Rate for Payer: Galaxy Health WC |
$25,380.15
|
| Rate for Payer: Global Benefits Group Commercial |
$17,915.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,873.10
|
| Rate for Payer: InnovAge PACE Commercial |
$14,929.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,915.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,376.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,482.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,971.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,901.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,901.30
|
| Rate for Payer: Multiplan Commercial |
$22,394.25
|
| Rate for Payer: Networks By Design Commercial |
$19,408.35
|
| Rate for Payer: Prime Health Services Commercial |
$25,380.15
|
| Rate for Payer: Riverside University Health System MISP |
$11,943.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,915.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,915.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,380.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,380.15
|
| Rate for Payer: Vantage Medical Group Senior |
$25,380.15
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$29,859.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,971.80 |
| Max. Negotiated Rate |
$26,873.10 |
| Rate for Payer: Adventist Health Commercial |
$5,971.80
|
| Rate for Payer: Cash Price |
$16,422.45
|
| Rate for Payer: Central Health Plan Commercial |
$23,887.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,943.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,943.60
|
| Rate for Payer: Galaxy Health WC |
$25,380.15
|
| Rate for Payer: Global Benefits Group Commercial |
$17,915.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,873.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,915.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,376.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,482.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,971.80
|
| Rate for Payer: Multiplan Commercial |
$22,394.25
|
| Rate for Payer: Networks By Design Commercial |
$19,408.35
|
| Rate for Payer: Prime Health Services Commercial |
$25,380.15
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$35,128.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,025.60 |
| Max. Negotiated Rate |
$31,615.20 |
| Rate for Payer: Adventist Health Commercial |
$7,025.60
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Central Health Plan Commercial |
$28,102.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,051.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,051.20
|
| Rate for Payer: Galaxy Health WC |
$29,858.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21,076.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,615.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,430.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,383.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,744.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,025.60
|
| Rate for Payer: Multiplan Commercial |
$26,346.00
|
| Rate for Payer: Networks By Design Commercial |
$22,833.20
|
| Rate for Payer: Prime Health Services Commercial |
$29,858.80
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$7,588.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,517.60 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,517.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,449.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,173.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,691.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$4,173.40
|
| Rate for Payer: Cash Price |
$4,173.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,070.40
|
| Rate for Payer: Cigna of CA HMO |
$4,932.20
|
| Rate for Payer: Cigna of CA PPO |
$5,615.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,449.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,449.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,449.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,035.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,035.20
|
| Rate for Payer: Galaxy Health WC |
$6,449.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,552.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,829.20
|
| Rate for Payer: InnovAge PACE Commercial |
$3,794.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,061.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,696.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,517.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,311.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,311.60
|
| Rate for Payer: Multiplan Commercial |
$5,691.00
|
| Rate for Payer: Networks By Design Commercial |
$4,932.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,449.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,035.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,552.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,552.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,449.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,449.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,449.80
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,785.40 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,909.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,695.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$4,909.85
|
| Rate for Payer: Cash Price |
$4,909.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: Cigna of CA HMO |
$5,802.55
|
| Rate for Payer: Cigna of CA PPO |
$6,605.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,587.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: InnovAge PACE Commercial |
$4,463.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,954.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,525.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,248.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,248.90
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,570.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,356.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,356.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,587.95
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$7,588.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,517.60 |
| Max. Negotiated Rate |
$6,829.20 |
| Rate for Payer: Adventist Health Commercial |
$1,517.60
|
| Rate for Payer: Cash Price |
$4,173.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,070.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,035.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,035.20
|
| Rate for Payer: Galaxy Health WC |
$6,449.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,552.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,829.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,061.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,891.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,696.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,517.60
|
| Rate for Payer: Multiplan Commercial |
$5,691.00
|
| Rate for Payer: Networks By Design Commercial |
$4,932.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,449.80
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,785.40 |
| Max. Negotiated Rate |
$8,034.30 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Cash Price |
$4,909.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,141.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,570.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,570.80
|
| Rate for Payer: Galaxy Health WC |
$7,587.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,356.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,034.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,954.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,401.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,525.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,785.40
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: Networks By Design Commercial |
$5,802.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,587.95
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$36,885.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,377.00 |
| Max. Negotiated Rate |
$33,196.50 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Central Health Plan Commercial |
$29,508.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,754.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,754.00
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,196.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,831.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,377.00
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$36,885.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$33,196.50 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22,400.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,352.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,286.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,663.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Central Health Plan Commercial |
$29,508.00
|
| Rate for Payer: Cigna of CA HMO |
$23,606.40
|
| Rate for Payer: Cigna of CA PPO |
$27,294.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,352.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,352.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,352.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,754.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14,754.00
|
| Rate for Payer: Galaxy Health WC |
$31,352.25
|
| Rate for Payer: Global Benefits Group Commercial |
$22,131.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,196.50
|
| Rate for Payer: InnovAge PACE Commercial |
$18,442.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,602.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,053.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,831.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,377.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,819.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,819.50
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
| Rate for Payer: Networks By Design Commercial |
$23,975.25
|
| Rate for Payer: Prime Health Services Commercial |
$31,352.25
|
| Rate for Payer: Riverside University Health System MISP |
$14,754.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,131.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,131.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,352.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,352.25
|
| Rate for Payer: Vantage Medical Group Senior |
$31,352.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$31,352.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,270.40 |
| Max. Negotiated Rate |
$28,216.80 |
| Rate for Payer: Adventist Health Commercial |
$6,270.40
|
| Rate for Payer: Cash Price |
$17,243.60
|
| Rate for Payer: Central Health Plan Commercial |
$25,081.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,540.80
|
| Rate for Payer: Galaxy Health WC |
$26,649.20
|
| Rate for Payer: Global Benefits Group Commercial |
$18,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,216.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,911.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,945.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,406.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.40
|
| Rate for Payer: Multiplan Commercial |
$23,514.00
|
| Rate for Payer: Networks By Design Commercial |
$20,378.80
|
| Rate for Payer: Prime Health Services Commercial |
$26,649.20
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$31,352.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$28,216.80 |
| Rate for Payer: Adventist Health Commercial |
$6,270.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19,040.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,649.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,243.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,514.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$17,243.60
|
| Rate for Payer: Cash Price |
$17,243.60
|
| Rate for Payer: Central Health Plan Commercial |
$25,081.60
|
| Rate for Payer: Cigna of CA HMO |
$20,065.28
|
| Rate for Payer: Cigna of CA PPO |
$23,200.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,649.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,649.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,649.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,540.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,540.80
|
| Rate for Payer: Galaxy Health WC |
$26,649.20
|
| Rate for Payer: Global Benefits Group Commercial |
$18,811.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,216.80
|
| Rate for Payer: InnovAge PACE Commercial |
$15,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,911.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,945.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,406.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,946.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,946.40
|
| Rate for Payer: Multiplan Commercial |
$23,514.00
|
| Rate for Payer: Networks By Design Commercial |
$20,378.80
|
| Rate for Payer: Prime Health Services Commercial |
$26,649.20
|
| Rate for Payer: Riverside University Health System MISP |
$12,540.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18,811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,649.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,649.20
|
| Rate for Payer: Vantage Medical Group Senior |
$26,649.20
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$18,971.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,794.20 |
| Max. Negotiated Rate |
$17,073.90 |
| Rate for Payer: Adventist Health Commercial |
$3,794.20
|
| Rate for Payer: Cash Price |
$10,434.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,588.40
|
| Rate for Payer: Galaxy Health WC |
$16,125.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,382.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,073.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,227.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,743.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,794.20
|
| Rate for Payer: Multiplan Commercial |
$14,228.25
|
| Rate for Payer: Networks By Design Commercial |
$12,331.15
|
| Rate for Payer: Prime Health Services Commercial |
$16,125.35
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$22,319.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,463.80 |
| Max. Negotiated Rate |
$20,087.10 |
| Rate for Payer: Adventist Health Commercial |
$4,463.80
|
| Rate for Payer: Cash Price |
$12,275.45
|
| Rate for Payer: Central Health Plan Commercial |
$17,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,927.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,927.60
|
| Rate for Payer: Galaxy Health WC |
$18,971.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,087.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,503.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,815.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.80
|
| Rate for Payer: Multiplan Commercial |
$16,739.25
|
| Rate for Payer: Networks By Design Commercial |
$14,507.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,971.15
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$22,319.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$930.83 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,463.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,971.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,275.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,739.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$12,275.45
|
| Rate for Payer: Cash Price |
$12,275.45
|
| Rate for Payer: Cash Price |
$12,275.45
|
| Rate for Payer: Central Health Plan Commercial |
$17,855.20
|
| Rate for Payer: Cigna of CA HMO |
$14,507.35
|
| Rate for Payer: Cigna of CA PPO |
$16,516.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,971.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,971.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,971.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,927.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,927.60
|
| Rate for Payer: Galaxy Health WC |
$18,971.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,087.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$930.83
|
| Rate for Payer: InnovAge PACE Commercial |
$11,159.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,815.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,623.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,623.30
|
| Rate for Payer: Multiplan Commercial |
$16,739.25
|
| Rate for Payer: Networks By Design Commercial |
$14,507.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,971.15
|
| Rate for Payer: Riverside University Health System MISP |
$8,927.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,391.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,391.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,971.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,971.15
|
| Rate for Payer: Vantage Medical Group Senior |
$18,971.15
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$18,971.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$930.83 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,794.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,125.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,434.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,228.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$10,434.05
|
| Rate for Payer: Cash Price |
$10,434.05
|
| Rate for Payer: Cash Price |
$10,434.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,176.80
|
| Rate for Payer: Cigna of CA HMO |
$12,331.15
|
| Rate for Payer: Cigna of CA PPO |
$14,038.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,125.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,125.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,125.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,588.40
|
| Rate for Payer: Galaxy Health WC |
$16,125.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,382.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,073.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$930.83
|
| Rate for Payer: InnovAge PACE Commercial |
$9,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,743.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,794.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,279.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,279.70
|
| Rate for Payer: Multiplan Commercial |
$14,228.25
|
| Rate for Payer: Networks By Design Commercial |
$12,331.15
|
| Rate for Payer: Prime Health Services Commercial |
$16,125.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,588.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,382.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,382.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,125.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,125.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16,125.35
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$28,367.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$25,530.30 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Central Health Plan Commercial |
$22,693.60
|
| Rate for Payer: Cigna of CA HMO |
$18,154.88
|
| Rate for Payer: Cigna of CA PPO |
$20,991.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$24,111.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,530.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,920.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| Rate for Payer: Networks By Design Commercial |
$18,438.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$24,111.95
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,020.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,020.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$33,373.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,674.60 |
| Max. Negotiated Rate |
$30,035.70 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,349.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13,349.20
|
| Rate for Payer: Galaxy Health WC |
$28,367.05
|
| Rate for Payer: Global Benefits Group Commercial |
$20,023.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,035.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,259.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,715.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,657.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.60
|
| Rate for Payer: Multiplan Commercial |
$25,029.75
|
| Rate for Payer: Networks By Design Commercial |
$21,692.45
|
| Rate for Payer: Prime Health Services Commercial |
$28,367.05
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$28,367.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,673.40 |
| Max. Negotiated Rate |
$25,530.30 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Central Health Plan Commercial |
$22,693.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,346.80
|
| Rate for Payer: Galaxy Health WC |
$24,111.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,530.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,920.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,559.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.40
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| Rate for Payer: Networks By Design Commercial |
$18,438.55
|
| Rate for Payer: Prime Health Services Commercial |
$24,111.95
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$33,373.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$30,035.70 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Central Health Plan Commercial |
$26,698.40
|
| Rate for Payer: Cigna of CA HMO |
$21,358.72
|
| Rate for Payer: Cigna of CA PPO |
$24,696.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$28,367.05
|
| Rate for Payer: Global Benefits Group Commercial |
$20,023.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,035.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,259.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,715.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$25,029.75
|
| Rate for Payer: Networks By Design Commercial |
$21,692.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Prime Health Services Commercial |
$28,367.05
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,023.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,023.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
