|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Adventist Health Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$256.80
|
| Rate for Payer: Galaxy Health WC |
$545.70
|
| Rate for Payer: Global Benefits Group Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$397.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Networks By Design Commercial |
$417.30
|
| Rate for Payer: Prime Health Services Commercial |
$545.70
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
|
|
HC EVAL SWALLOW/ORAL FUNC
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
905601753
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$81.95 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$335.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$536.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$613.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna of CA HMO |
$523.52
|
| Rate for Payer: Cigna of CA PPO |
$605.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$695.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$695.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$572.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$572.60
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$695.30
|
| Rate for Payer: Vantage Medical Group Senior |
$695.30
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
|
|
HC EVAL SWALLOW/ORAL FUNC MCAL
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
907000023
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$81.95 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$335.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$536.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$613.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna of CA HMO |
$523.52
|
| Rate for Payer: Cigna of CA PPO |
$605.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$695.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$695.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$572.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$572.60
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$531.70
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$695.30
|
| Rate for Payer: Vantage Medical Group Senior |
$695.30
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$197.80 |
| Max. Negotiated Rate |
$840.65 |
| Rate for Payer: Adventist Health Commercial |
$197.80
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.60
|
| Rate for Payer: EPIC Health Plan Senior |
$395.60
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$376.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$791.20
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
|
|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$67.12 |
| Max. Negotiated Rate |
$840.65 |
| Rate for Payer: Adventist Health Commercial |
$405.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$648.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$840.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$543.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$741.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cigna of CA HMO |
$632.96
|
| Rate for Payer: Cigna of CA PPO |
$731.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$840.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$840.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$840.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.60
|
| Rate for Payer: EPIC Health Plan Senior |
$395.60
|
| Rate for Payer: Galaxy Health WC |
$840.65
|
| Rate for Payer: Global Benefits Group Commercial |
$593.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$659.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$692.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$692.30
|
| Rate for Payer: Multiplan Commercial |
$791.20
|
| Rate for Payer: Networks By Design Commercial |
$642.85
|
| Rate for Payer: Prime Health Services Commercial |
$840.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$593.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$593.40
|
| 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 |
$840.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$840.65
|
| Rate for Payer: Vantage Medical Group Senior |
$840.65
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$604.35 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$137.58 |
| Max. Negotiated Rate |
$604.35 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$466.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO |
$455.04
|
| Rate for Payer: Cigna of CA PPO |
$526.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$137.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| 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 |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
IP
|
$4,762.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
906820288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.40 |
| Max. Negotiated Rate |
$4,047.70 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.88
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
IP
|
$4,899.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$979.80 |
| Max. Negotiated Rate |
$4,164.15 |
| Rate for Payer: Adventist Health Commercial |
$979.80
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,959.60
|
| Rate for Payer: Galaxy Health WC |
$4,164.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,939.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,267.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,866.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,032.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.76
|
| Rate for Payer: Multiplan Commercial |
$3,919.20
|
| Rate for Payer: Networks By Design Commercial |
$3,184.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,164.15
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$4,899.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.83 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$979.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,164.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,694.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,674.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: Cigna of CA HMO |
$3,135.36
|
| Rate for Payer: Cigna of CA PPO |
$3,625.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,164.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,164.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,164.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,959.60
|
| Rate for Payer: Galaxy Health WC |
$4,164.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,939.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,267.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,032.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,429.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,429.30
|
| Rate for Payer: Multiplan Commercial |
$3,919.20
|
| Rate for Payer: Networks By Design Commercial |
$3,184.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,164.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,939.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$4,164.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,164.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,164.15
|
|
|
HC EVASC ST RPR THRC/AA ACRS BR
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
906820288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.83 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,619.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,571.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cigna of CA HMO |
$3,047.68
|
| Rate for Payer: Cigna of CA PPO |
$3,523.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,047.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,047.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,333.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,333.40
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,857.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$4,899.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$979.80 |
| Max. Negotiated Rate |
$4,164.15 |
| Rate for Payer: Adventist Health Commercial |
$979.80
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,959.60
|
| Rate for Payer: Galaxy Health WC |
$4,164.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,939.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,267.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,866.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,032.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.76
|
| Rate for Payer: Multiplan Commercial |
$3,919.20
|
| Rate for Payer: Networks By Design Commercial |
$3,184.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,164.15
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$4,762.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
906820289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,619.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,571.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: Cigna of CA HMO |
$3,047.68
|
| Rate for Payer: Cigna of CA PPO |
$3,523.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,047.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,047.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,047.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,078.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,333.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,333.40
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,857.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,047.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
IP
|
$4,762.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
906820289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.40 |
| Max. Negotiated Rate |
$4,047.70 |
| Rate for Payer: Adventist Health Commercial |
$952.40
|
| Rate for Payer: Cash Price |
$2,142.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,904.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,904.80
|
| Rate for Payer: Galaxy Health WC |
$4,047.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,857.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,176.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,947.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,142.88
|
| Rate for Payer: Multiplan Commercial |
$3,809.60
|
| Rate for Payer: Networks By Design Commercial |
$3,095.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,047.70
|
|
|
HC EVASC ST RPR THRC/AA NO CRSG BR
|
Facility
|
OP
|
$4,899.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$979.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$979.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,164.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,694.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,674.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: Cash Price |
$2,204.55
|
| Rate for Payer: Cigna of CA HMO |
$3,135.36
|
| Rate for Payer: Cigna of CA PPO |
$3,625.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,164.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,164.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,164.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,959.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,959.60
|
| Rate for Payer: Galaxy Health WC |
$4,164.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,939.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,078.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,267.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,220.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,032.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,429.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,429.30
|
| Rate for Payer: Multiplan Commercial |
$3,919.20
|
| Rate for Payer: Networks By Design Commercial |
$3,184.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,164.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,939.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$4,164.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,164.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,164.15
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
IP
|
$29,872.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,974.40 |
| Max. Negotiated Rate |
$25,391.20 |
| Rate for Payer: Adventist Health Commercial |
$5,974.40
|
| Rate for Payer: Cash Price |
$13,442.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,948.80
|
| Rate for Payer: Galaxy Health WC |
$25,391.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,923.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,924.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,381.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,490.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,169.28
|
| Rate for Payer: Multiplan Commercial |
$23,897.60
|
| Rate for Payer: Networks By Design Commercial |
$19,416.80
|
| Rate for Payer: Prime Health Services Commercial |
$25,391.20
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
OP
|
$29,872.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,974.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$13,442.40
|
| Rate for Payer: Cash Price |
$13,442.40
|
| Rate for Payer: Cash Price |
$13,442.40
|
| Rate for Payer: Cigna of CA HMO |
$19,118.08
|
| Rate for Payer: Cigna of CA PPO |
$22,105.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$25,391.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,923.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,924.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,381.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,169.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$23,897.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$19,416.80
|
| Rate for Payer: Prime Health Services Commercial |
$25,391.20
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,923.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| 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: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
IP
|
$48,430.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,686.00 |
| Max. Negotiated Rate |
$41,165.50 |
| Rate for Payer: Adventist Health Commercial |
$9,686.00
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,372.00
|
| Rate for Payer: Galaxy Health WC |
$41,165.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,058.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,302.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,451.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,978.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,623.20
|
| Rate for Payer: Multiplan Commercial |
$38,744.00
|
| Rate for Payer: Networks By Design Commercial |
$31,479.50
|
| Rate for Payer: Prime Health Services Commercial |
$41,165.50
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
OP
|
$48,430.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$72,933.49 |
| Rate for Payer: Adventist Health Commercial |
$9,686.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66,707.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48,918.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,471.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: Cigna of CA HMO |
$30,995.20
|
| Rate for Payer: Cigna of CA PPO |
$35,838.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,707.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,918.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44,471.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,036.71
|
| Rate for Payer: EPIC Health Plan Senior |
$44,471.64
|
| Rate for Payer: Galaxy Health WC |
$41,165.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,058.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$72,933.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44,471.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,302.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,451.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,471.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,623.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,034.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59,592.00
|
| Rate for Payer: Multiplan Commercial |
$38,744.00
|
| Rate for Payer: Networks By Design Commercial |
$31,479.50
|
| Rate for Payer: Prime Health Services Commercial |
$41,165.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,058.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| 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: Upland Medical Group Pediatric |
$44,471.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66,707.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,918.80
|
| Rate for Payer: Vantage Medical Group Senior |
$44,471.64
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,413.27
|
| Rate for Payer: Blue Shield of California EPN |
$930.69
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,109.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,413.27
|
| Rate for Payer: Blue Shield of California EPN |
$930.69
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,277.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,185.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
