|
HC ATHRECTOMY & STENT TIBIOPERONE
|
Facility
|
OP
|
$48,422.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
909020072
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$9,684.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,158.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,632.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,316.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Cigna of CA HMO |
$30,990.08
|
| Rate for Payer: Cigna of CA PPO |
$35,832.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,158.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,158.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,158.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,895.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19,368.80
|
| Rate for Payer: Galaxy Health WC |
$41,158.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,053.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,747.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,577.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,568.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,621.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,895.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,895.40
|
| Rate for Payer: Multiplan Commercial |
$38,737.60
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,474.30
|
| Rate for Payer: Prime Health Services Commercial |
$41,158.70
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,053.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,211.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,158.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,158.70
|
| Rate for Payer: Vantage Medical Group Senior |
$41,158.70
|
|
|
HC ATHRECTOMY & STENT TIBIOPERONE
|
Facility
|
IP
|
$48,422.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
909020072
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,684.40 |
| Max. Negotiated Rate |
$41,158.70 |
| Rate for Payer: Adventist Health Commercial |
$9,684.40
|
| Rate for Payer: Cash Price |
$21,789.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,895.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19,368.80
|
| Rate for Payer: Galaxy Health WC |
$41,158.70
|
| Rate for Payer: Global Benefits Group Commercial |
$29,053.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,747.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,568.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,621.28
|
| Rate for Payer: Multiplan Commercial |
$38,737.60
|
| Rate for Payer: Networks By Design Commercial |
$31,474.30
|
| Rate for Payer: Prime Health Services Commercial |
$41,158.70
|
|
|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
|
OP
|
$27,371.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,054.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,528.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cigna of CA HMO |
$17,517.44
|
| Rate for Payer: Cigna of CA PPO |
$20,254.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,265.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,265.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,935.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,159.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,159.70
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,422.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,685.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Senior |
$23,265.35
|
|
|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
|
IP
|
$27,371.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,474.20 |
| Max. Negotiated Rate |
$23,265.35 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
OP
|
$27,371.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,638.65 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,054.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,528.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Cigna of CA HMO |
$17,517.44
|
| Rate for Payer: Cigna of CA PPO |
$20,254.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,265.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,265.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,935.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,159.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,159.70
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,422.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,685.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,265.35
|
| Rate for Payer: Vantage Medical Group Senior |
$23,265.35
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
IP
|
$27,371.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,474.20 |
| Max. Negotiated Rate |
$23,265.35 |
| Rate for Payer: Adventist Health Commercial |
$5,474.20
|
| Rate for Payer: Cash Price |
$12,316.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,159.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,948.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,948.40
|
| Rate for Payer: Galaxy Health WC |
$23,265.35
|
| Rate for Payer: Global Benefits Group Commercial |
$16,422.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,148.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,569.04
|
| Rate for Payer: Multiplan Commercial |
$21,896.80
|
| Rate for Payer: Networks By Design Commercial |
$17,791.15
|
| Rate for Payer: Prime Health Services Commercial |
$23,265.35
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
IP
|
$31,637.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,327.40 |
| Max. Negotiated Rate |
$26,891.45 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,654.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,654.80
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,665.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
OP
|
$31,637.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,327.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,891.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,400.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,727.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cash Price |
$14,236.65
|
| Rate for Payer: Cigna of CA HMO |
$20,247.68
|
| Rate for Payer: Cigna of CA PPO |
$23,411.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,891.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,891.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,891.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,145.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,654.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12,654.80
|
| Rate for Payer: Galaxy Health WC |
$26,891.45
|
| Rate for Payer: Global Benefits Group Commercial |
$18,982.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,089.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,484.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,665.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,592.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,145.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,145.90
|
| Rate for Payer: Multiplan Commercial |
$25,309.60
|
| Rate for Payer: Networks By Design Commercial |
$20,564.05
|
| Rate for Payer: Prime Health Services Commercial |
$26,891.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,982.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,818.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,891.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,891.45
|
| Rate for Payer: Vantage Medical Group Senior |
$26,891.45
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
IP
|
$10,226.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,045.20 |
| Max. Negotiated Rate |
$8,692.10 |
| Rate for Payer: Adventist Health Commercial |
$2,045.20
|
| Rate for Payer: Cash Price |
$4,601.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,158.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.40
|
| Rate for Payer: Galaxy Health WC |
$8,692.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,493.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.24
|
| Rate for Payer: Multiplan Commercial |
$8,180.80
|
| Rate for Payer: Networks By Design Commercial |
$6,646.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.10
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
OP
|
$10,226.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,053.91 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,045.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,692.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,624.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,669.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$4,601.70
|
| Rate for Payer: Cash Price |
$4,601.70
|
| Rate for Payer: Cash Price |
$4,601.70
|
| Rate for Payer: Cigna of CA HMO |
$6,544.64
|
| Rate for Payer: Cigna of CA PPO |
$7,567.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,692.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,692.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,692.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,158.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.40
|
| Rate for Payer: Galaxy Health WC |
$8,692.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,053.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,493.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,191.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,158.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,158.20
|
| Rate for Payer: Multiplan Commercial |
$8,180.80
|
| Rate for Payer: Networks By Design Commercial |
$6,646.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,692.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,692.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,692.10
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018130
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018130
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018230
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018230
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018232
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018132
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018132
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018232
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018131
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018131
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018231
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018231
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC AUD EP NRO DGNTC W INT AND RPT
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
900600653
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$515.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$294.40
|
| Rate for Payer: Galaxy Health WC |
$625.60
|
| Rate for Payer: Global Benefits Group Commercial |
$441.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$467.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Networks By Design Commercial |
$478.40
|
| Rate for Payer: Prime Health Services Commercial |
$625.60
|
|
|
HC AUD EP NRO DGNTC W INT AND RPT
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
900600653
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$129.23 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$472.29
|
| Rate for Payer: Blue Shield of California Commercial |
$309.86
|
| Rate for Payer: Blue Shield of California Commercial |
$469.57
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$471.04
|
| Rate for Payer: Cigna of CA PPO |
$544.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$515.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$625.60
|
| Rate for Payer: Global Benefits Group Commercial |
$441.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$467.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Networks By Design Commercial |
$478.40
|
| Rate for Payer: Prime Health Services Commercial |
$625.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$441.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$441.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$43.14 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$404.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$472.29
|
| Rate for Payer: Blue Shield of California Commercial |
$469.57
|
| Rate for Payer: Blue Shield of California Commercial |
$309.86
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$471.04
|
| Rate for Payer: Cigna of CA PPO |
$544.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$625.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$625.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$515.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$294.40
|
| Rate for Payer: Galaxy Health WC |
$625.60
|
| Rate for Payer: Global Benefits Group Commercial |
$441.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$467.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Networks By Design Commercial |
$478.40
|
| Rate for Payer: Prime Health Services Commercial |
$625.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$441.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$441.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$625.60
|
| Rate for Payer: Vantage Medical Group Senior |
$625.60
|
|
