|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.00 |
| Max. Negotiated Rate |
$1,245.25 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.00
|
| Rate for Payer: EPIC Health Plan Senior |
$586.00
|
| Rate for Payer: Galaxy Health WC |
$1,245.25
|
| Rate for Payer: Global Benefits Group Commercial |
$879.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$906.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.00
|
| Rate for Payer: Networks By Design Commercial |
$952.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,245.25
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.00 |
| Max. Negotiated Rate |
$1,245.25 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.00
|
| Rate for Payer: EPIC Health Plan Senior |
$586.00
|
| Rate for Payer: Galaxy Health WC |
$1,245.25
|
| Rate for Payer: Global Benefits Group Commercial |
$879.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$906.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.00
|
| Rate for Payer: Networks By Design Commercial |
$952.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,245.25
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cigna of CA HMO |
$937.60
|
| Rate for Payer: Cigna of CA PPO |
$1,084.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,245.25
|
| Rate for Payer: Global Benefits Group Commercial |
$879.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,172.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$952.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,245.25
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$732.50
|
| Rate for Payer: United Healthcare All Other HMO |
$732.50
|
| Rate for Payer: United Healthcare HMO Rider |
$732.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$732.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
909000111
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$179.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: Cigna of CA HMO |
$575.36
|
| Rate for Payer: Cigna of CA PPO |
$665.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$764.15
|
| Rate for Payer: Global Benefits Group Commercial |
$539.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$599.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$719.20
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$584.35
|
| Rate for Payer: Prime Health Services Commercial |
$764.15
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$539.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
909000111
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.80 |
| Max. Negotiated Rate |
$764.15 |
| Rate for Payer: Adventist Health Commercial |
$179.80
|
| Rate for Payer: Cash Price |
$404.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.60
|
| Rate for Payer: EPIC Health Plan Senior |
$359.60
|
| Rate for Payer: Galaxy Health WC |
$764.15
|
| Rate for Payer: Global Benefits Group Commercial |
$539.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$599.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$556.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.76
|
| Rate for Payer: Multiplan Commercial |
$719.20
|
| Rate for Payer: Networks By Design Commercial |
$584.35
|
| Rate for Payer: Prime Health Services Commercial |
$764.15
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cigna of CA HMO |
$937.60
|
| Rate for Payer: Cigna of CA PPO |
$1,084.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,245.25
|
| Rate for Payer: Global Benefits Group Commercial |
$879.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,172.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$952.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,245.25
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$293.00 |
| Max. Negotiated Rate |
$1,245.25 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.00
|
| Rate for Payer: EPIC Health Plan Senior |
$586.00
|
| Rate for Payer: Galaxy Health WC |
$1,245.25
|
| Rate for Payer: Global Benefits Group Commercial |
$879.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$906.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Multiplan Commercial |
$1,172.00
|
| Rate for Payer: Networks By Design Commercial |
$952.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,245.25
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cash Price |
$659.25
|
| Rate for Payer: Cigna of CA HMO |
$937.60
|
| Rate for Payer: Cigna of CA PPO |
$1,084.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,245.25
|
| Rate for Payer: Global Benefits Group Commercial |
$879.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,172.00
|
| Rate for Payer: Networks By Design Commercial |
$952.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,245.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$879.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$732.50
|
| Rate for Payer: United Healthcare All Other HMO |
$732.50
|
| Rate for Payer: United Healthcare HMO Rider |
$732.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$732.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ASSAY OF INTERLEUKIN 6 (IL 6)
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83529
|
| Hospital Charge Code |
900915379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$48.01 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.01
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC ASSAY OF INTERLEUKIN 6 (IL 6)
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83529
|
| Hospital Charge Code |
900915379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
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 |
$86.02 |
| Max. Negotiated Rate |
$623.05 |
| Rate for Payer: Adventist Health Commercial |
$300.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$480.77
|
| 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 |
$549.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| 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 Medi-Cal |
$623.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$623.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$293.20
|
| Rate for Payer: Galaxy Health WC |
$623.05
|
| Rate for Payer: Global Benefits Group Commercial |
$439.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.02
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$453.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$513.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$513.10
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| 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 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 |
$146.60 |
| Max. Negotiated Rate |
$623.05 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$329.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$453.73
|
| 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 AST
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| 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 |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| 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 |
$12.00
|
| 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 |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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: Upland Medical Group Pediatric |
$5.18
|
| 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
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC AST INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| 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 |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| 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 |
$12.00
|
| 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 |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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: Upland Medical Group Pediatric |
$5.18
|
| 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
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
OP
|
$25,924.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,184.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,258.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,443.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,919.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: Cigna of CA HMO |
$16,591.36
|
| Rate for Payer: Cigna of CA PPO |
$19,183.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,035.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,035.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,369.60
|
| Rate for Payer: Galaxy Health WC |
$22,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15,554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,291.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,877.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,046.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,146.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,146.80
|
| Rate for Payer: Multiplan Commercial |
$20,739.20
|
| Rate for Payer: Networks By Design Commercial |
$16,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,035.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,962.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,035.40
|
| Rate for Payer: Vantage Medical Group Senior |
$22,035.40
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
IP
|
$25,924.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,184.80 |
| Max. Negotiated Rate |
$22,035.40 |
| Rate for Payer: Adventist Health Commercial |
$5,184.80
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,369.60
|
| Rate for Payer: Galaxy Health WC |
$22,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15,554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,291.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,877.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,046.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.76
|
| Rate for Payer: Multiplan Commercial |
$20,739.20
|
| Rate for Payer: Networks By Design Commercial |
$16,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,035.40
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
OP
|
$25,924.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,184.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,258.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,443.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,919.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: Cigna of CA HMO |
$16,591.36
|
| Rate for Payer: Cigna of CA PPO |
$19,183.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,035.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,035.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,369.60
|
| Rate for Payer: Galaxy Health WC |
$22,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15,554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,291.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,877.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,046.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,146.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,146.80
|
| Rate for Payer: Multiplan Commercial |
$20,739.20
|
| Rate for Payer: Networks By Design Commercial |
$16,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,035.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,962.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,035.40
|
| Rate for Payer: Vantage Medical Group Senior |
$22,035.40
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
IP
|
$25,924.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,184.80 |
| Max. Negotiated Rate |
$22,035.40 |
| Rate for Payer: Adventist Health Commercial |
$5,184.80
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,369.60
|
| Rate for Payer: Galaxy Health WC |
$22,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15,554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,291.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,877.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,046.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.76
|
| Rate for Payer: Multiplan Commercial |
$20,739.20
|
| Rate for Payer: Networks By Design Commercial |
$16,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,035.40
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.60 |
| Max. Negotiated Rate |
$1,413.55 |
| Rate for Payer: Adventist Health Commercial |
$332.60
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.20
|
| Rate for Payer: EPIC Health Plan Senior |
$665.20
|
| Rate for Payer: Galaxy Health WC |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,109.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,029.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| Rate for Payer: Multiplan Commercial |
$1,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.60 |
| Max. Negotiated Rate |
$1,413.55 |
| Rate for Payer: Adventist Health Commercial |
$332.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,090.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,413.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,247.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,021.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.76
|
| Rate for Payer: Blue Shield of California EPN |
$671.85
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cigna of CA HMO |
$1,064.32
|
| Rate for Payer: Cigna of CA PPO |
$1,230.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,413.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,413.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,413.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.20
|
| Rate for Payer: EPIC Health Plan Senior |
$665.20
|
| Rate for Payer: Galaxy Health WC |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,109.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,029.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,164.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,164.10
|
| Rate for Payer: Multiplan Commercial |
$1,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$831.50
|
| Rate for Payer: United Healthcare All Other HMO |
$831.50
|
| Rate for Payer: United Healthcare HMO Rider |
$831.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$831.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,413.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,413.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,413.55
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
OP
|
$25,924.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,184.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,258.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,443.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,919.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: Cigna of CA HMO |
$16,591.36
|
| Rate for Payer: Cigna of CA PPO |
$19,183.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,035.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,035.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,369.60
|
| Rate for Payer: Galaxy Health WC |
$22,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15,554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,291.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,877.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,046.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,146.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,146.80
|
| Rate for Payer: Multiplan Commercial |
$20,739.20
|
| Rate for Payer: Networks By Design Commercial |
$16,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,035.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,962.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,035.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,035.40
|
| Rate for Payer: Vantage Medical Group Senior |
$22,035.40
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
IP
|
$25,924.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,184.80 |
| Max. Negotiated Rate |
$22,035.40 |
| Rate for Payer: Adventist Health Commercial |
$5,184.80
|
| Rate for Payer: Cash Price |
$11,665.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,369.60
|
| Rate for Payer: Galaxy Health WC |
$22,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$15,554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,291.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,877.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,046.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,221.76
|
| Rate for Payer: Multiplan Commercial |
$20,739.20
|
| Rate for Payer: Networks By Design Commercial |
$16,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$22,035.40
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
|
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$2,827.10 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.40
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$798.24
|
| Rate for Payer: Multiplan Commercial |
$2,660.80
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
|
