|
HC EVAL SPEECH SOUND PROD W LANG COMP EXPRES
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
900100002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$154.08 |
| Max. Negotiated Rate |
$1,210.31 |
| Rate for Payer: Cigna of CA PPO |
$475.08
|
| Rate for Payer: Adventist Health Commercial |
$263.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,210.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna of CA HMO |
$410.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$545.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$545.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.40
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.20
|
| 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 |
$545.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$545.70
|
| Rate for Payer: Vantage Medical Group Senior |
$545.70
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$449.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$407.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.78
|
| 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
|
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 |
$455.93
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$572.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.62
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$572.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.62
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$572.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.62
|
| 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 |
$455.93
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$572.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$519.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$482.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$692.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$628.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.51
|
| 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 |
$779.34
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$692.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$628.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.51
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| 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 |
$668.04 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$668.04
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| 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
|
OP
|
$4,899.00
|
|
|
Service Code
|
CPT 33894
|
| Hospital Charge Code |
909033894
|
|
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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,429.30
|
| 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 |
$1,356.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,110.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,534.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.41
|
| 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 |
$2,449.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,429.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,110.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.41
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,429.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,110.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.41
|
| 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
|
$4,899.00
|
|
|
Service Code
|
CPT 33895
|
| Hospital Charge Code |
909033895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.78 |
| 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 |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,429.30
|
| 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 |
$215.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,110.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.41
|
| 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 |
$2,449.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 EVENT MONITOR HOOK UP
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
912000115
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC EVENT MONITOR HOOK UP
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
912000115
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$1,477.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.00
|
| Rate for Payer: Blue Shield of California Commercial |
$50.52
|
| Rate for Payer: Blue Shield of California Commercial |
$76.56
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,006.00
|
| Rate for Payer: United Healthcare HMO Rider |
$765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$701.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC EVEROLIMUS B
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC EVEROLIMUS B
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.19
|
| Rate for Payer: Blue Shield of California Commercial |
$40.57
|
| Rate for Payer: Blue Shield of California Commercial |
$100.50
|
| Rate for Payer: Blue Shield of California Commercial |
$61.34
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| 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 |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| 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 |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,910.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18,968.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,624.48
|
| 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 |
$594.18 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,974.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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 |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,910.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| 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/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,968.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,843.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,169.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| 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 |
$14,936.00
|
| 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 |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37278
|
| Hospital Charge Code |
906811844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,800.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cigna of CA HMO |
$18,385.92
|
| Rate for Payer: Cigna of CA PPO |
$21,258.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,418.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,418.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,428.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,894.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,109.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,109.60
|
| Rate for Payer: Multiplan Commercial |
$22,982.40
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,236.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,418.80
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37278
|
| Hospital Charge Code |
906811844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,745.60 |
| Max. Negotiated Rate |
$24,418.80 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,894.72
|
| Rate for Payer: Multiplan Commercial |
$22,982.40
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37277
|
| Hospital Charge Code |
906811843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$48,836.75 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cigna of CA HMO |
$36,771.20
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,856.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,789.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$45,964.00
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37277
|
| Hospital Charge Code |
906811843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$48,836.75 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,789.20
|
| Rate for Payer: Multiplan Commercial |
$45,964.00
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37276
|
| Hospital Charge Code |
906811842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,800.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,546.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,434.76
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cigna of CA HMO |
$18,385.92
|
| Rate for Payer: Cigna of CA PPO |
$21,258.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,418.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,418.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,428.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,894.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,109.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,109.60
|
| Rate for Payer: Multiplan Commercial |
$22,982.40
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,236.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,418.80
|
|
