|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.36 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,866.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA PPO |
$11,928.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Dignity Health Media |
$13,702.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,090.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,672.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,868.80 |
| Max. Negotiated Rate |
$13,702.00 |
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,448.00
|
| Rate for Payer: Galaxy Health WC |
$13,702.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,672.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,752.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,868.80
|
| Rate for Payer: Multiplan Commercial |
$12,896.00
|
| Rate for Payer: Networks By Design Commercial |
$10,478.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,702.00
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,085.66 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,085.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,045.36 |
| Max. Negotiated Rate |
$21,410.65 |
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,075.60
|
| Rate for Payer: Galaxy Health WC |
$21,410.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,801.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,597.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,045.36
|
| Rate for Payer: Multiplan Commercial |
$20,151.20
|
| Rate for Payer: Networks By Design Commercial |
$16,372.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,410.65
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$826.73 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,384.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$15,113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cigna of CA PPO |
$18,639.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$21,410.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15,113.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,891.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,801.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,045.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$20,151.20
|
| Rate for Payer: Networks By Design Commercial |
$16,372.85
|
| Rate for Payer: Prime Health Services Commercial |
$21,410.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
IP
|
$973.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$233.52 |
| Max. Negotiated Rate |
$827.05 |
| Rate for Payer: Cash Price |
$437.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.20
|
| Rate for Payer: Galaxy Health WC |
$827.05
|
| Rate for Payer: Global Benefits Group Commercial |
$583.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.52
|
| Rate for Payer: Multiplan Commercial |
$778.40
|
| Rate for Payer: Networks By Design Commercial |
$632.45
|
| Rate for Payer: Prime Health Services Commercial |
$827.05
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
OP
|
$973.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$827.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$638.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$583.80
|
| 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 |
$437.85
|
| Rate for Payer: Cash Price |
$437.85
|
| Rate for Payer: Cash Price |
$437.85
|
| Rate for Payer: Cigna of CA HMO |
$622.72
|
| Rate for Payer: Cigna of CA PPO |
$720.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.05
|
| Rate for Payer: Dignity Health Media |
$827.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$389.20
|
| Rate for Payer: Galaxy Health WC |
$827.05
|
| Rate for Payer: Global Benefits Group Commercial |
$583.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$729.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.52
|
| Rate for Payer: Multiplan Commercial |
$778.40
|
| Rate for Payer: Networks By Design Commercial |
$632.45
|
| Rate for Payer: Prime Health Services Commercial |
$827.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$583.80
|
| 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 |
$827.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.05
|
| Rate for Payer: Vantage Medical Group Senior |
$827.05
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
908697163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,054.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$384.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$682.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$682.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$744.00
|
| 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 |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cigna of CA HMO |
$793.60
|
| Rate for Payer: Cigna of CA PPO |
$917.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.00
|
| Rate for Payer: Dignity Health Media |
$1,054.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,054.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$496.00
|
| Rate for Payer: Galaxy Health WC |
$1,054.00
|
| Rate for Payer: Global Benefits Group Commercial |
$744.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: Networks By Design Commercial |
$806.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$744.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$744.00
|
| 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 |
$1,054.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,054.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,054.00
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,054.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$384.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$682.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$682.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$744.00
|
| 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 |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cigna of CA HMO |
$793.60
|
| Rate for Payer: Cigna of CA PPO |
$917.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.00
|
| Rate for Payer: Dignity Health Media |
$1,054.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,054.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$496.00
|
| Rate for Payer: Galaxy Health WC |
$1,054.00
|
| Rate for Payer: Global Benefits Group Commercial |
$744.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: Networks By Design Commercial |
$806.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$744.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$744.00
|
| 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 |
$1,054.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,054.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,054.00
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
908697163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,054.00 |
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.00
|
| Rate for Payer: Galaxy Health WC |
$1,054.00
|
| Rate for Payer: Global Benefits Group Commercial |
$744.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: Networks By Design Commercial |
$806.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.00
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,054.00 |
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.00
|
| Rate for Payer: Galaxy Health WC |
$1,054.00
|
| Rate for Payer: Global Benefits Group Commercial |
$744.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$827.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: Networks By Design Commercial |
$806.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,054.00
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
908697161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.24
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.24
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$384.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$495.60
|
| 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 |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna of CA HMO |
$528.64
|
| Rate for Payer: Cigna of CA PPO |
$611.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Media |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$619.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.24
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| 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 |
$702.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
908697161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$384.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$495.60
|
| 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 |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna of CA HMO |
$528.64
|
| Rate for Payer: Cigna of CA PPO |
$611.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Media |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$619.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.24
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| 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 |
$702.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
908697162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$247.92 |
| Max. Negotiated Rate |
$878.05 |
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.92
|
| Rate for Payer: Multiplan Commercial |
$826.40
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$247.92 |
| Max. Negotiated Rate |
$878.05 |
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.92
|
| Rate for Payer: Multiplan Commercial |
$826.40
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
900497162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$878.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$384.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$878.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$619.80
|
| 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 |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cigna of CA HMO |
$661.12
|
| Rate for Payer: Cigna of CA PPO |
$764.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$878.05
|
| Rate for Payer: Dignity Health Media |
$878.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$878.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$774.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.92
|
| Rate for Payer: Multiplan Commercial |
$826.40
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.80
|
| 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 |
$878.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$878.05
|
| Rate for Payer: Vantage Medical Group Senior |
$878.05
|
|
|
HC PT INIT EVAL MODERATE
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
908697162
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$878.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$384.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$878.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$619.80
|
| 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 |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cash Price |
$464.85
|
| Rate for Payer: Cigna of CA HMO |
$661.12
|
| Rate for Payer: Cigna of CA PPO |
$764.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$878.05
|
| Rate for Payer: Dignity Health Media |
$878.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$878.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$413.20
|
| Rate for Payer: Galaxy Health WC |
$878.05
|
| Rate for Payer: Global Benefits Group Commercial |
$619.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$774.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.92
|
| Rate for Payer: Multiplan Commercial |
$826.40
|
| Rate for Payer: Networks By Design Commercial |
$671.45
|
| Rate for Payer: Prime Health Services Commercial |
$878.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.80
|
| 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 |
$878.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$878.05
|
| Rate for Payer: Vantage Medical Group Senior |
$878.05
|
|
|
HC PT RE-EVALUATION
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$125.28 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$259.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$313.20
|
| 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 |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna of CA HMO |
$334.08
|
| Rate for Payer: Cigna of CA PPO |
$386.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Media |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$391.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| 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 |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC PT RE-EVALUATION
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
900409008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$125.28 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
|
|
HC PT RE-EVALUATION MCAL
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 97002
|
| Hospital Charge Code |
900400034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$137.04 |
| Max. Negotiated Rate |
$485.35 |
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.40
|
| Rate for Payer: Galaxy Health WC |
$485.35
|
| Rate for Payer: Global Benefits Group Commercial |
$342.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.04
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Networks By Design Commercial |
$371.15
|
| Rate for Payer: Prime Health Services Commercial |
$485.35
|
|
|
HC PT RE-EVALUATION MCAL
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 97002
|
| Hospital Charge Code |
900400034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$137.04 |
| Max. Negotiated Rate |
$485.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$374.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$485.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$314.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$314.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$342.60
|
| 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 |
$256.95
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cigna of CA HMO |
$365.44
|
| Rate for Payer: Cigna of CA PPO |
$422.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$485.35
|
| Rate for Payer: Dignity Health Media |
$485.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$485.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.40
|
| Rate for Payer: Galaxy Health WC |
$485.35
|
| Rate for Payer: Global Benefits Group Commercial |
$342.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$428.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.04
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Networks By Design Commercial |
$371.15
|
| Rate for Payer: Prime Health Services Commercial |
$485.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.60
|
| 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 |
$485.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$485.35
|
| Rate for Payer: Vantage Medical Group Senior |
$485.35
|
|
|
HC PT SUBSTITUTION
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 85611
|
| Hospital Charge Code |
900910105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$35.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.93
|
| 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 |
$5.91
|
| Rate for Payer: Dignity Health Media |
$3.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.94
|
| 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 |
$6.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.28
|
| 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 |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Vantage Medical Group Senior |
$3.94
|
|
