|
HC DISCOGRAM C SPINE
|
Facility
|
OP
|
$4,701.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.79 |
| Max. Negotiated Rate |
$4,144.02 |
| Rate for Payer: Adventist Health Commercial |
$940.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,462.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,979.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.24
|
| Rate for Payer: Cash Price |
$2,115.45
|
| Rate for Payer: Cash Price |
$2,115.45
|
| Rate for Payer: Cigna of CA HMO |
$3,008.64
|
| Rate for Payer: Cigna of CA PPO |
$3,478.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,290.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$3,995.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,820.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,985.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$3,760.80
|
| Rate for Payer: Networks By Design Commercial |
$3,055.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,995.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,820.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,820.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
IP
|
$6,846.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,369.20 |
| Max. Negotiated Rate |
$5,819.10 |
| Rate for Payer: Adventist Health Commercial |
$1,369.20
|
| Rate for Payer: Cash Price |
$3,080.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,738.40
|
| Rate for Payer: Galaxy Health WC |
$5,819.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,107.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,347.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,039.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.04
|
| Rate for Payer: Multiplan Commercial |
$5,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,449.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,819.10
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
OP
|
$6,846.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$5,819.10 |
| Rate for Payer: Adventist Health Commercial |
$1,369.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$635.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,305.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,882.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4,367.75
|
| Rate for Payer: Cash Price |
$3,080.70
|
| Rate for Payer: Cash Price |
$3,080.70
|
| Rate for Payer: Cigna of CA HMO |
$4,381.44
|
| Rate for Payer: Cigna of CA PPO |
$5,066.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$5,819.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,107.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,347.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,449.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,819.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,107.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,107.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC DISK ASPIRATION
|
Facility
|
IP
|
$15,758.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.60 |
| Max. Negotiated Rate |
$13,394.30 |
| Rate for Payer: Adventist Health Commercial |
$3,151.60
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,030.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,303.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,303.20
|
| Rate for Payer: Galaxy Health WC |
$13,394.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,006.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,297.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.92
|
| Rate for Payer: Multiplan Commercial |
$12,606.40
|
| Rate for Payer: Networks By Design Commercial |
$10,242.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,394.30
|
|
|
HC DISK ASPIRATION
|
Facility
|
OP
|
$15,758.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,250.93 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: Cigna of CA HMO |
$10,085.12
|
| Rate for Payer: Cigna of CA PPO |
$11,660.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,030.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$13,394.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,250.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,006.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,164.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$12,606.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$10,242.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,394.30
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,879.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$349.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$477.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$407.04
|
| Rate for Payer: Cigna of CA PPO |
$470.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$540.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$540.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$445.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$403.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$445.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$445.20
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.00
|
| Rate for Payer: United Healthcare All Other HMO |
$318.00
|
| Rate for Payer: United Healthcare HMO Rider |
$318.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$540.60
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$349.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$477.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$413.40
|
| Rate for Payer: Cigna of CA PPO |
$470.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$540.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$540.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$445.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$403.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$445.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$445.20
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$540.60
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$445.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$403.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$445.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Senior |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$403.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
|
|
HC DIST PROD EVOKED OTO EMSNS LMTD EVAL
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
908603071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
|
|
HC DIST PROD EVOKED OTO EMSNS LMTD EVAL
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
908603071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$219.62
|
| 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 |
$445.34
|
| Rate for Payer: Blue Shield of California Commercial |
$292.17
|
| Rate for Payer: Blue Shield of California Commercial |
$442.77
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO |
$444.16
|
| Rate for Payer: Cigna of CA PPO |
$513.56
|
| 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 |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| 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 |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| 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 DLTR VESSEL 5FR
|
Facility
|
IP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$43.21 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$40.67
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
OP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$43.21 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.62
|
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Cigna of CA HMO |
$32.54
|
| Rate for Payer: Cigna of CA PPO |
$37.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$40.67
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.42
|
| Rate for Payer: United Healthcare All Other HMO |
$25.42
|
| Rate for Payer: United Healthcare HMO Rider |
$25.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.21
|
| Rate for Payer: Vantage Medical Group Senior |
$43.21
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
OP
|
$53.79
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$45.72 |
| Rate for Payer: Adventist Health Commercial |
$10.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.52
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Cigna of CA HMO |
$34.43
|
| Rate for Payer: Cigna of CA PPO |
$39.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.65
|
| Rate for Payer: Multiplan Commercial |
$43.03
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.89
|
| Rate for Payer: United Healthcare All Other HMO |
$26.89
|
| Rate for Payer: United Healthcare HMO Rider |
$26.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.72
|
| Rate for Payer: Vantage Medical Group Senior |
$45.72
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
IP
|
$53.79
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$45.72 |
| Rate for Payer: Adventist Health Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: EPIC Health Plan Senior |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$43.03
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
OP
|
$53.30
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.20
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cigna of CA HMO |
$34.11
|
| Rate for Payer: Cigna of CA PPO |
$39.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.31
|
| Rate for Payer: Multiplan Commercial |
$42.64
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.65
|
| Rate for Payer: United Healthcare All Other HMO |
$26.65
|
| Rate for Payer: United Healthcare HMO Rider |
$26.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.30
|
| Rate for Payer: Vantage Medical Group Senior |
$45.30
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
IP
|
$53.30
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Multiplan Commercial |
$42.64
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$208.57 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,432.27
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$810.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,562.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
905365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
|
|
HC DLX OTS/CUSTOM MOLDED PER SHOE
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT A5508
|
| Hospital Charge Code |
915365508
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$208.57 |
| Max. Negotiated Rate |
$1,897.20 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,674.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,432.27
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cash Price |
$1,004.40
|
| Rate for Payer: Cigna of CA HMO |
$1,428.48
|
| Rate for Payer: Cigna of CA PPO |
$1,651.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,897.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,897.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,562.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.80
|
| Rate for Payer: EPIC Health Plan Senior |
$892.80
|
| Rate for Payer: Galaxy Health WC |
$1,897.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,339.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,417.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$810.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,562.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,562.40
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Networks By Design Commercial |
$1,450.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,897.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,339.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,339.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,897.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,897.20
|
|
|
HC DM ED SELF MGMT >5 PATIENTS
|
Facility
|
IP
|
$9.46
|
|
|
Service Code
|
CPT 98962 U2
|
| Hospital Charge Code |
950942003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Adventist Health Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$8.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.15
|
| Rate for Payer: Prime Health Services Commercial |
$8.04
|
|
|
HC DM ED SELF MGMT >5 PATIENTS
|
Facility
|
OP
|
$9.46
|
|
|
Service Code
|
CPT 98962 U2
|
| Hospital Charge Code |
950942003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.07
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cigna of CA HMO |
$6.05
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.78
|
| Rate for Payer: EPIC Health Plan Senior |
$3.78
|
| Rate for Payer: Galaxy Health WC |
$8.04
|
| Rate for Payer: Global Benefits Group Commercial |
$5.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.62
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.15
|
| Rate for Payer: Prime Health Services Commercial |
$8.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.04
|
| Rate for Payer: Vantage Medical Group Senior |
$8.04
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.83
|
| Rate for Payer: Blue Shield of California Commercial |
$16.60
|
| Rate for Payer: Blue Shield of California Commercial |
$149.16
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$98.65
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.67
|
| Rate for Payer: EPIC Health Plan Senior |
$15.11
|
| Rate for Payer: EPIC Health Plan Senior |
$15.11
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
