|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$271.20
|
| Rate for Payer: Blue Shield of California Commercial |
$284.31
|
| Rate for Payer: Blue Shield of California EPN |
$221.03
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$339.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.04
|
| Rate for Payer: Blue Distinction Transplant |
$271.20
|
| Rate for Payer: Blue Shield of California Commercial |
$279.34
|
| Rate for Payer: Blue Shield of California EPN |
$219.67
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$339.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: InnovAge PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Riverside University Health System MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
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: Blue Shield of California EPN |
$133.50
|
| 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: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| 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 |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.40
|
| Rate for Payer: United Healthcare All Other HMO |
$92.20
|
| Rate for Payer: United Healthcare HMO Rider |
$90.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.50
|
|
|
HC RIB BELT CUSTOM FABRICATED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
905350220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.51 |
| Max. Negotiated Rate |
$225.00 |
| 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 |
$137.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.70
|
| Rate for Payer: Blue Distinction Transplant |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$187.50
|
| Rate for Payer: Blue Shield of California EPN |
$136.00
|
| 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 Media |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$187.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| 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 |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC RIBS BILATERAL
|
Facility
|
OP
|
$1,421.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.55
|
| Rate for Payer: Blue Distinction Transplant |
$852.60
|
| Rate for Payer: Blue Shield of California Commercial |
$878.18
|
| Rate for Payer: Blue Shield of California EPN |
$690.61
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.80
|
| Rate for Payer: Cigna of CA HMO |
$909.44
|
| Rate for Payer: Cigna of CA PPO |
$1,051.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,065.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,065.75
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$852.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC RIBS BILATERAL
|
Facility
|
IP
|
$1,421.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Cash Price |
$639.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.40
|
| Rate for Payer: Galaxy Health WC |
$1,207.85
|
| Rate for Payer: Global Benefits Group Commercial |
$852.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,278.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$1,065.75
|
| Rate for Payer: Networks By Design Commercial |
$923.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.85
|
|
|
HC RIBS UNILATERAL
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$1,005.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.53
|
| Rate for Payer: Blue Distinction Transplant |
$670.20
|
| Rate for Payer: Blue Shield of California Commercial |
$690.31
|
| Rate for Payer: Blue Shield of California EPN |
$542.86
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$502.65
|
| Rate for Payer: Cash Price |
$502.65
|
| Rate for Payer: Central Health Plan Commercial |
$893.60
|
| Rate for Payer: Cigna of CA HMO |
$714.88
|
| Rate for Payer: Cigna of CA PPO |
$826.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$949.45
|
| Rate for Payer: Global Benefits Group Commercial |
$670.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,005.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$837.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$837.75
|
| Rate for Payer: Networks By Design Commercial |
$726.05
|
| Rate for Payer: Prime Health Services Commercial |
$949.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC RIBS UNILATERAL
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.40 |
| Max. Negotiated Rate |
$1,005.30 |
| Rate for Payer: Cash Price |
$502.65
|
| Rate for Payer: Central Health Plan Commercial |
$893.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.80
|
| Rate for Payer: Galaxy Health WC |
$949.45
|
| Rate for Payer: Global Benefits Group Commercial |
$670.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,005.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.40
|
| Rate for Payer: Multiplan Commercial |
$837.75
|
| Rate for Payer: Networks By Design Commercial |
$726.05
|
| Rate for Payer: Prime Health Services Commercial |
$949.45
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,327.40 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,482.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,920.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,894.40
|
| Rate for Payer: Cigna of CA PPO |
$11,002.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$12,637.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,381.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,151.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,973.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$11,151.00
|
| Rate for Payer: Networks By Design Commercial |
$9,664.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,637.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,920.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,327.40 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,482.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,920.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,894.40
|
| Rate for Payer: Cigna of CA PPO |
$11,002.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$12,637.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,381.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,151.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,327.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,973.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$11,151.00
|
| Rate for Payer: Networks By Design Commercial |
$9,664.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,637.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,920.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,973.60 |
| Max. Negotiated Rate |
$13,381.20 |
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,947.20
|
| Rate for Payer: Galaxy Health WC |
$12,637.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,381.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,664.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,973.60
|
| Rate for Payer: Multiplan Commercial |
$11,151.00
|
| Rate for Payer: Networks By Design Commercial |
$9,664.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,637.80
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,973.60 |
| Max. Negotiated Rate |
$13,381.20 |
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Central Health Plan Commercial |
$11,894.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,947.20
|
| Rate for Payer: Galaxy Health WC |
$12,637.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,920.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,381.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,664.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,973.60
|
| Rate for Payer: Multiplan Commercial |
$11,151.00
|
| Rate for Payer: Networks By Design Commercial |
$9,664.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,637.80
|
|
|
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 |
$431.40 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.40
|
| 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 |
$1,501.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,321.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,612.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,638.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,717.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,334.97
|
| Rate for Payer: Cash Price |
$1,228.50
|
| 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 Media |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,047.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$955.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| 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
|
| 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 Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
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: 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: 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 Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| 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 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: 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: 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 Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| 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 TTS BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.40 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.40
|
| 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 |
$1,501.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,321.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,612.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,638.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,717.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,334.97
|
| Rate for Payer: Cash Price |
$1,228.50
|
| 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 Media |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,092.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,047.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$955.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.13
|
| 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
|
| 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 Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
IP
|
$846.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
OP
|
$846.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$513.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.82
|
| Rate for Payer: Blue Distinction Transplant |
$507.60
|
| Rate for Payer: Blue Shield of California Commercial |
$522.83
|
| Rate for Payer: Blue Shield of California EPN |
$411.16
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA HMO |
$541.44
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Media |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$634.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$296.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Riverside University Health System MISP |
$338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.00
|
| Rate for Payer: United Healthcare All Other HMO |
$423.00
|
| Rate for Payer: United Healthcare HMO Rider |
$423.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
OP
|
$8,819.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,024.97 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,291.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,968.55
|
| Rate for Payer: Cash Price |
$3,968.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,055.20
|
| Rate for Payer: Cigna of CA PPO |
$6,526.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$7,496.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,291.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,937.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,614.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,882.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,024.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$6,614.25
|
| Rate for Payer: Networks By Design Commercial |
$5,732.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,496.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,291.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
IP
|
$8,819.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,763.80 |
| Max. Negotiated Rate |
$7,937.10 |
| Rate for Payer: Cash Price |
$3,968.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,055.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,527.60
|
| Rate for Payer: Galaxy Health WC |
$7,496.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,291.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,937.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,882.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,360.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.80
|
| Rate for Payer: Multiplan Commercial |
$6,614.25
|
| Rate for Payer: Networks By Design Commercial |
$5,732.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,496.15
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$3,638.70 |
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,617.20
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.42 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,120.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,425.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$2,120.62
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,234.40
|
| Rate for Payer: Cigna of CA PPO |
$2,991.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$3,436.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,425.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,638.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,032.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,499.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: InnovAge PACE Commercial |
$3,180.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,696.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,841.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: Networks By Design Commercial |
$2,627.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,436.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,247.86
|
| Rate for Payer: Riverside University Health System MISP |
$2,332.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,425.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
OP
|
$7,743.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.67 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,678.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,645.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,678.93
|
| Rate for Payer: Cash Price |
$3,484.35
|
| Rate for Payer: Cash Price |
$3,484.35
|
| Rate for Payer: Central Health Plan Commercial |
$6,194.40
|
| Rate for Payer: Cigna of CA PPO |
$5,729.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$6,581.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,645.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,968.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,807.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,720.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: InnovAge PACE Commercial |
$7,018.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,548.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,269.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$5,807.25
|
| Rate for Payer: Networks By Design Commercial |
$5,032.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,581.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,959.67
|
| Rate for Payer: Riverside University Health System MISP |
$5,146.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,645.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
