|
HC VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$18,185.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906820030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,622.68 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,637.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cigna of CA HMO |
$11,820.25
|
| Rate for Payer: Cigna of CA PPO |
$13,456.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$15,457.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,911.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,622.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,835.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,364.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$14,548.00
|
| Rate for Payer: Networks By Design Commercial |
$11,820.25
|
| Rate for Payer: Prime Health Services Commercial |
$15,457.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,911.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,911.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$18,711.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,742.20 |
| Max. Negotiated Rate |
$15,904.35 |
| Rate for Payer: Adventist Health Commercial |
$3,742.20
|
| Rate for Payer: Cash Price |
$10,291.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,484.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,484.40
|
| Rate for Payer: Galaxy Health WC |
$15,904.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,226.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,128.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,582.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,490.64
|
| Rate for Payer: Multiplan Commercial |
$14,968.80
|
| Rate for Payer: Networks By Design Commercial |
$12,162.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,904.35
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$18,185.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906820030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,637.00 |
| Max. Negotiated Rate |
$15,457.25 |
| Rate for Payer: Adventist Health Commercial |
$3,637.00
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,274.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,274.00
|
| Rate for Payer: Galaxy Health WC |
$15,457.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,911.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,928.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,256.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,364.40
|
| Rate for Payer: Multiplan Commercial |
$14,548.00
|
| Rate for Payer: Networks By Design Commercial |
$11,820.25
|
| Rate for Payer: Prime Health Services Commercial |
$15,457.25
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$18,711.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,622.68 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,742.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$10,291.05
|
| Rate for Payer: Cash Price |
$10,291.05
|
| Rate for Payer: Cash Price |
$10,291.05
|
| Rate for Payer: Cigna of CA HMO |
$12,162.15
|
| Rate for Payer: Cigna of CA PPO |
$13,846.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$15,904.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,226.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,622.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,835.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,490.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$14,968.80
|
| Rate for Payer: Networks By Design Commercial |
$12,162.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,904.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,226.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,226.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$12,474.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$350.73 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,494.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$6,860.70
|
| Rate for Payer: Cash Price |
$6,860.70
|
| Rate for Payer: Cash Price |
$6,860.70
|
| Rate for Payer: Cigna of CA HMO |
$8,108.10
|
| Rate for Payer: Cigna of CA PPO |
$9,230.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$10,602.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,484.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,993.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$9,979.20
|
| Rate for Payer: Networks By Design Commercial |
$8,108.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,602.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,484.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,484.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$12,123.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906820033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$350.73 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,424.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cigna of CA HMO |
$7,879.95
|
| Rate for Payer: Cigna of CA PPO |
$8,971.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$10,304.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,273.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,086.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$9,698.40
|
| Rate for Payer: Networks By Design Commercial |
$7,879.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,304.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,273.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,273.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$12,474.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,494.80 |
| Max. Negotiated Rate |
$10,602.90 |
| Rate for Payer: Adventist Health Commercial |
$2,494.80
|
| Rate for Payer: Cash Price |
$6,860.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,989.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,989.60
|
| Rate for Payer: Galaxy Health WC |
$10,602.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,484.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,752.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,721.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,993.76
|
| Rate for Payer: Multiplan Commercial |
$9,979.20
|
| Rate for Payer: Networks By Design Commercial |
$8,108.10
|
| Rate for Payer: Prime Health Services Commercial |
$10,602.90
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$12,123.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906820033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,424.60 |
| Max. Negotiated Rate |
$10,304.55 |
| Rate for Payer: Adventist Health Commercial |
$2,424.60
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,849.20
|
| Rate for Payer: Galaxy Health WC |
$10,304.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,273.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,086.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,618.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,504.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,909.52
|
| Rate for Payer: Multiplan Commercial |
$9,698.40
|
| Rate for Payer: Networks By Design Commercial |
$7,879.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,304.55
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$13,788.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.95 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,757.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$7,583.40
|
| Rate for Payer: Cash Price |
$7,583.40
|
| Rate for Payer: Cash Price |
$7,583.40
|
| Rate for Payer: Cigna of CA HMO |
$8,962.20
|
| Rate for Payer: Cigna of CA PPO |
$10,203.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$11,719.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,272.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,375.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,196.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,309.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$11,030.40
|
| Rate for Payer: Networks By Design Commercial |
$8,962.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,719.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,272.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,272.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$13,401.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.95 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,680.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cigna of CA HMO |
$8,710.65
|
| Rate for Payer: Cigna of CA PPO |
$9,916.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$11,390.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,040.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,375.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,938.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,216.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$10,720.80
|
| Rate for Payer: Networks By Design Commercial |
$8,710.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,390.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,040.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,040.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$13,401.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,680.20 |
| Max. Negotiated Rate |
$11,390.85 |
| Rate for Payer: Adventist Health Commercial |
$2,680.20
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,360.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,360.40
|
| Rate for Payer: Galaxy Health WC |
$11,390.85
|
| Rate for Payer: Global Benefits Group Commercial |
$8,040.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,938.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,105.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,295.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,216.24
|
| Rate for Payer: Multiplan Commercial |
$10,720.80
|
| Rate for Payer: Networks By Design Commercial |
$8,710.65
|
| Rate for Payer: Prime Health Services Commercial |
$11,390.85
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$13,788.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,757.60 |
| Max. Negotiated Rate |
$11,719.80 |
| Rate for Payer: Adventist Health Commercial |
$2,757.60
|
| Rate for Payer: Cash Price |
$7,583.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,515.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,515.20
|
| Rate for Payer: Galaxy Health WC |
$11,719.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,272.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,196.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,253.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,534.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,309.12
|
| Rate for Payer: Multiplan Commercial |
$11,030.40
|
| Rate for Payer: Networks By Design Commercial |
$8,962.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,719.80
|
|
|
HC VANCOMYCIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC VANCOMYCIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
900910934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.79
|
| Rate for Payer: Blue Shield of California Commercial |
$163.91
|
| Rate for Payer: Blue Shield of California EPN |
$108.29
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Cash Price |
$134.75
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.28
|
| Rate for Payer: EPIC Health Plan Senior |
$13.54
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Other HMO |
$10.97
|
| Rate for Payer: United Healthcare HMO Rider |
$10.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC VANILMANDELIC ACID
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
900910531
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$153.14 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.14
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: EPIC Health Plan Senior |
$15.50
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$385.90 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.96
|
| Rate for Payer: Blue Shield of California Commercial |
$335.05
|
| Rate for Payer: Blue Shield of California EPN |
$220.64
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$385.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$272.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$272.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.90
|
| Rate for Payer: Vantage Medical Group Senior |
$385.90
|
|
|
HC VAN SONNENBERG SUMP (COOK)
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$90.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cigna of CA HMO |
$317.80
|
| Rate for Payer: Cigna of CA PPO |
$317.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Senior |
$181.60
|
| Rate for Payer: Galaxy Health WC |
$385.90
|
| Rate for Payer: Global Benefits Group Commercial |
$272.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$302.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$281.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.96
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: Networks By Design Commercial |
$227.00
|
| Rate for Payer: Prime Health Services Commercial |
$385.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.39
|
| Rate for Payer: United Healthcare All Other HMO |
$165.85
|
| Rate for Payer: United Healthcare HMO Rider |
$162.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.69
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$144.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$123.02 |
| Rate for Payer: Adventist Health Commercial |
$28.95
|
| Rate for Payer: Cash Price |
$79.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.89
|
| Rate for Payer: EPIC Health Plan Senior |
$57.89
|
| Rate for Payer: Galaxy Health WC |
$123.02
|
| Rate for Payer: Global Benefits Group Commercial |
$86.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.74
|
| Rate for Payer: Multiplan Commercial |
$115.78
|
| Rate for Payer: Networks By Design Commercial |
$94.07
|
| Rate for Payer: Prime Health Services Commercial |
$123.02
|
|
|
HC VARICELLA ZOSTER ANTIBODY
|
Facility
|
OP
|
$144.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913671
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Adventist Health Commercial |
$28.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$96.82
|
| Rate for Payer: Blue Shield of California EPN |
$63.97
|
| Rate for Payer: Cash Price |
$79.60
|
| Rate for Payer: Cash Price |
$79.60
|
| Rate for Payer: Cigna of CA HMO |
$92.63
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$123.02
|
| Rate for Payer: Global Benefits Group Commercial |
$86.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$115.78
|
| Rate for Payer: Networks By Design Commercial |
$94.07
|
| Rate for Payer: Prime Health Services Commercial |
$123.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
905352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.11
|
| Rate for Payer: Blue Shield of California Commercial |
$173.43
|
| Rate for Payer: Blue Shield of California EPN |
$114.21
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VAR/VALGUS CORRECTION MODIFICA ADDITON LE
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT L2275
|
| Hospital Charge Code |
915352275
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$96.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.11
|
| Rate for Payer: Blue Shield of California Commercial |
$173.43
|
| Rate for Payer: Blue Shield of California EPN |
$114.21
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cigna of CA HMO |
$164.50
|
| Rate for Payer: Cigna of CA PPO |
$164.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.50
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$117.50
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.20
|
| Rate for Payer: United Healthcare All Other HMO |
$85.85
|
| Rate for Payer: United Healthcare HMO Rider |
$83.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.75
|
| Rate for Payer: Vantage Medical Group Senior |
$199.75
|
|
|
HC VASC EMBOLIZATION, VENOUS, TUMORS, ORG ISCHEM, INFARC
|
Facility
|
IP
|
$22,357.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
900100013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,471.40 |
| Max. Negotiated Rate |
$19,003.45 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Cash Price |
$12,296.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,942.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,942.80
|
| Rate for Payer: Galaxy Health WC |
$19,003.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,414.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,518.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,838.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,365.68
|
| Rate for Payer: Multiplan Commercial |
$17,885.60
|
| Rate for Payer: Networks By Design Commercial |
$14,532.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,003.45
|
|
