|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.24 |
| Max. Negotiated Rate |
$957.10 |
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.40
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
|
|
HC ASPIRATION INJECTION SM JONT W US GUID
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.81 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$675.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA PPO |
$833.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$844.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASPIRATION INJECTION SM JONT W US GUID
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.24 |
| Max. Negotiated Rate |
$957.10 |
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.40
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
IP
|
$1,267.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.08 |
| Max. Negotiated Rate |
$1,076.95 |
| Rate for Payer: Cash Price |
$570.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.80
|
| Rate for Payer: Galaxy Health WC |
$1,076.95
|
| Rate for Payer: Global Benefits Group Commercial |
$760.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$845.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.08
|
| Rate for Payer: Multiplan Commercial |
$1,013.60
|
| Rate for Payer: Networks By Design Commercial |
$823.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.95
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
OP
|
$1,267.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$760.20
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$570.15
|
| Rate for Payer: Cash Price |
$570.15
|
| Rate for Payer: Cigna of CA PPO |
$937.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,076.95
|
| Rate for Payer: Global Benefits Group Commercial |
$760.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$950.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$845.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,013.60
|
| Rate for Payer: Networks By Design Commercial |
$823.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$760.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
OP
|
$1,267.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.28 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$760.20
|
| Rate for Payer: Cash Price |
$570.15
|
| Rate for Payer: Cash Price |
$570.15
|
| Rate for Payer: Cash Price |
$570.15
|
| Rate for Payer: Cigna of CA PPO |
$937.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,076.95
|
| Rate for Payer: Global Benefits Group Commercial |
$760.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$950.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$845.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,013.60
|
| Rate for Payer: Networks By Design Commercial |
$823.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$760.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$633.50
|
| Rate for Payer: United Healthcare All Other HMO |
$633.50
|
| Rate for Payer: United Healthcare HMO Rider |
$633.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$633.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
IP
|
$1,267.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.08 |
| Max. Negotiated Rate |
$1,076.95 |
| Rate for Payer: Cash Price |
$570.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.80
|
| Rate for Payer: Galaxy Health WC |
$1,076.95
|
| Rate for Payer: Global Benefits Group Commercial |
$760.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$845.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.08
|
| Rate for Payer: Multiplan Commercial |
$1,013.60
|
| Rate for Payer: Networks By Design Commercial |
$823.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,076.95
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
IP
|
$5,073.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,217.52 |
| Max. Negotiated Rate |
$4,312.05 |
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,029.20
|
| Rate for Payer: Galaxy Health WC |
$4,312.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,043.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,383.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,932.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,217.52
|
| Rate for Payer: Multiplan Commercial |
$4,058.40
|
| Rate for Payer: Networks By Design Commercial |
$3,297.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.05
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
OP
|
$5,073.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,043.80
|
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: Cigna of CA PPO |
$3,754.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$4,312.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,043.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,804.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,383.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,217.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$4,058.40
|
| Rate for Payer: Networks By Design Commercial |
$3,297.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,043.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,536.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,536.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,536.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,536.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
IP
|
$5,073.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,217.52 |
| Max. Negotiated Rate |
$4,312.05 |
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,029.20
|
| Rate for Payer: Galaxy Health WC |
$4,312.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,043.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,383.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,932.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,217.52
|
| Rate for Payer: Multiplan Commercial |
$4,058.40
|
| Rate for Payer: Networks By Design Commercial |
$3,297.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.05
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
OP
|
$5,073.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,043.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: Cigna of CA PPO |
$3,754.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$4,312.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,043.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,804.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,383.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,217.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$4,058.40
|
| Rate for Payer: Networks By Design Commercial |
$3,297.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,043.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
909000111
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$782.00 |
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.00
|
| Rate for Payer: Galaxy Health WC |
$782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$552.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$613.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Networks By Design Commercial |
$598.00
|
| Rate for Payer: Prime Health Services Commercial |
$782.00
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,034.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,293.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
909000111
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$552.00
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna of CA PPO |
$680.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$552.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$690.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$613.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Networks By Design Commercial |
$598.00
|
| Rate for Payer: Prime Health Services Commercial |
$782.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$413.76 |
| Max. Negotiated Rate |
$1,465.40 |
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.76 |
| Max. Negotiated Rate |
$1,465.40 |
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,034.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,270.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,006.82
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna of CA HMO |
$1,103.36
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,293.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.00
|
| Rate for Payer: United Healthcare All Other HMO |
$862.00
|
| Rate for Payer: United Healthcare HMO Rider |
$862.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$413.76 |
| Max. Negotiated Rate |
$1,465.40 |
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,034.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,293.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$413.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.00
|
| Rate for Payer: United Healthcare All Other HMO |
$862.00
|
| Rate for Payer: United Healthcare HMO Rider |
$862.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$175.92 |
| Max. Negotiated Rate |
$623.05 |
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.20
|
| Rate for Payer: Galaxy Health WC |
$623.05
|
| Rate for Payer: Global Benefits Group Commercial |
$439.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.92
|
| Rate for Payer: Multiplan Commercial |
$586.40
|
| Rate for Payer: Networks By Design Commercial |
$476.45
|
| Rate for Payer: Prime Health Services Commercial |
$623.05
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$97.28 |
| Max. Negotiated Rate |
$707.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$707.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$439.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: Cigna of CA HMO |
$469.12
|
| Rate for Payer: Cigna of CA PPO |
$542.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.05
|
| Rate for Payer: Dignity Health Media |
$623.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$293.20
|
| Rate for Payer: Galaxy Health WC |
$623.05
|
| Rate for Payer: Global Benefits Group Commercial |
$439.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$549.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.92
|
| Rate for Payer: Multiplan Commercial |
$586.40
|
| Rate for Payer: Networks By Design Commercial |
$476.45
|
| Rate for Payer: Prime Health Services Commercial |
$623.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$439.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$439.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.05
|
| Rate for Payer: Vantage Medical Group Senior |
$623.05
|
|
|
HC AST
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$47.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.17
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST INDIVIDUAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$47.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.17
|
| Rate for Payer: Blue Distinction Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.69
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Media |
$5.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
IP
|
$25,169.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,040.56 |
| Max. Negotiated Rate |
$21,393.65 |
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,067.60
|
| Rate for Payer: Galaxy Health WC |
$21,393.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,101.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,787.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,589.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,040.56
|
| Rate for Payer: Multiplan Commercial |
$20,135.20
|
| Rate for Payer: Networks By Design Commercial |
$16,359.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,393.65
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
OP
|
$25,169.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$21,393.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,508.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,842.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,842.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,995.69
|
| Rate for Payer: Blue Distinction Transplant |
$15,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cash Price |
$11,326.05
|
| Rate for Payer: Cigna of CA PPO |
$18,625.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Dignity Health Media |
$21,393.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,393.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,067.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$10,067.60
|
| Rate for Payer: Galaxy Health WC |
$21,393.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,101.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,876.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,787.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,589.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,040.56
|
| Rate for Payer: Multiplan Commercial |
$20,135.20
|
| Rate for Payer: Networks By Design Commercial |
$16,359.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,393.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,584.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12,584.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12,584.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,584.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,393.65
|
| Rate for Payer: Vantage Medical Group Senior |
$21,393.65
|
|
