|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$363.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.21
|
| Rate for Payer: Blue Shield of California Commercial |
$362.99
|
| Rate for Payer: Blue Shield of California EPN |
$237.41
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$245.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$363.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.21
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$120.25
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Preferred Health Network WC |
$122.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Prime Health Services WC |
$119.02
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
905350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
905350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.31 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.82
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Riverside University Health System MISP |
$100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
915350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.31 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.82
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Riverside University Health System MISP |
$100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
915350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC RIB BELT CUSTOM FITTED
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
905350210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Blue Shield of California Commercial |
$120.59
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$109.20
|
| Rate for Payer: Cigna of CA PPO |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.55
|
| Rate for Payer: United Healthcare All Other HMO |
$56.99
|
| Rate for Payer: United Healthcare HMO Rider |
$55.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.09
|
|
|
HC RIB BELT CUSTOM FITTED
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
905350210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.09 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.62
|
| Rate for Payer: Blue Shield of California Commercial |
$120.59
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$109.20
|
| Rate for Payer: Cigna of CA PPO |
$109.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.55
|
| Rate for Payer: United Healthcare All Other HMO |
$56.99
|
| Rate for Payer: United Healthcare HMO Rider |
$55.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC RIBS BILATERAL
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Adventist Health Commercial |
$315.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$957.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.37
|
| Rate for Payer: Blue Shield of California Commercial |
$957.24
|
| Rate for Payer: Blue Shield of California EPN |
$626.07
|
| Rate for Payer: Cash Price |
$709.65
|
| Rate for Payer: Cash Price |
$709.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,261.60
|
| Rate for Payer: Cigna of CA HMO |
$1,009.28
|
| Rate for Payer: Cigna of CA PPO |
$1,166.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,340.45
|
| Rate for Payer: Global Benefits Group Commercial |
$946.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,419.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,051.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,182.75
|
| Rate for Payer: Networks By Design Commercial |
$1,025.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,340.45
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$946.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$946.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC RIBS BILATERAL
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.40 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Adventist Health Commercial |
$315.40
|
| Rate for Payer: Cash Price |
$709.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,261.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$630.80
|
| Rate for Payer: Galaxy Health WC |
$1,340.45
|
| Rate for Payer: Global Benefits Group Commercial |
$946.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,419.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,051.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$600.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$976.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.40
|
| Rate for Payer: Multiplan Commercial |
$1,182.75
|
| Rate for Payer: Networks By Design Commercial |
$1,025.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,340.45
|
|
|
HC RIBS UNILATERAL
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Adventist Health Commercial |
$248.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$753.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.21
|
| Rate for Payer: Blue Shield of California Commercial |
$752.68
|
| Rate for Payer: Blue Shield of California EPN |
$492.28
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Central Health Plan Commercial |
$992.00
|
| Rate for Payer: Cigna of CA HMO |
$793.60
|
| Rate for Payer: Cigna of CA PPO |
$917.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,054.00
|
| Rate for Payer: Global Benefits Group Commercial |
$744.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,116.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$827.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$930.00
|
| Rate for Payer: Networks By Design Commercial |
$806.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.00
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$744.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$744.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC RIBS UNILATERAL
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.00 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Adventist Health Commercial |
$248.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Central Health Plan Commercial |
$992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.00
|
| Rate for Payer: EPIC Health Plan Senior |
$496.00
|
| Rate for Payer: Galaxy Health WC |
$1,054.00
|
| Rate for Payer: Global Benefits Group Commercial |
$744.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,116.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$827.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$472.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$767.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.00
|
| Rate for Payer: Multiplan Commercial |
$930.00
|
| Rate for Payer: Networks By Design Commercial |
$806.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.00
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$14,125.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,201.64 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,825.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,300.00
|
| Rate for Payer: Cigna of CA HMO |
$9,181.25
|
| Rate for Payer: Cigna of CA PPO |
$10,452.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$12,006.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,712.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,201.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,421.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$10,593.75
|
| Rate for Payer: Networks By Design Commercial |
$9,181.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$12,006.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,475.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$14,125.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,825.00 |
| Max. Negotiated Rate |
$12,712.50 |
| Rate for Payer: Adventist Health Commercial |
$2,825.00
|
| Rate for Payer: Cash Price |
$6,356.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,650.00
|
| Rate for Payer: Galaxy Health WC |
$12,006.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,475.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,712.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,421.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,381.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,743.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,825.00
|
| Rate for Payer: Multiplan Commercial |
$10,593.75
|
| Rate for Payer: Networks By Design Commercial |
$9,181.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,006.25
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$12,006.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,401.20 |
| Max. Negotiated Rate |
$10,805.40 |
| Rate for Payer: Adventist Health Commercial |
$2,401.20
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,802.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,802.40
|
| Rate for Payer: Galaxy Health WC |
$10,205.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,203.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,805.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,574.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,431.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,401.20
|
| Rate for Payer: Multiplan Commercial |
$9,004.50
|
| Rate for Payer: Networks By Design Commercial |
$7,803.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,205.10
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$12,006.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,201.64 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,401.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,604.80
|
| Rate for Payer: Cigna of CA HMO |
$7,803.90
|
| Rate for Payer: Cigna of CA PPO |
$8,884.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$10,205.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,203.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,805.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,201.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,008.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,401.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$9,004.50
|
| Rate for Payer: Networks By Design Commercial |
$7,803.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$10,205.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,203.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RIGIFLEX OTW BALLOON DILATOR
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
|
|
HC RIGIFLEX OTW BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,657.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,321.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,603.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,668.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.27
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,747.20
|
| Rate for Payer: Cigna of CA PPO |
$2,020.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,365.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,365.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,657.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,321.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,603.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,668.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.27
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: Cigna of CA HMO |
$1,747.20
|
| Rate for Payer: Cigna of CA PPO |
$2,020.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,092.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,365.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,365.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,092.00
|
| Rate for Payer: Galaxy Health WC |
$2,320.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,638.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,457.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,040.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,689.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Networks By Design Commercial |
$1,774.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,320.50
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
