|
HC PREPARE FACE/ORAL PROSTHESIS
|
Facility
|
OP
|
$7,530.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
900501350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$1,506.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cigna of CA HMO |
$4,819.20
|
| Rate for Payer: Cigna of CA PPO |
$5,572.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$6,400.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,518.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,807.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$6,024.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$4,894.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,400.50
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,518.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,765.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$810.05 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$625.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.24
|
| Rate for Payer: Blue Shield of California Commercial |
$583.24
|
| Rate for Payer: Blue Shield of California EPN |
$385.01
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cigna of CA HMO |
$609.92
|
| Rate for Payer: Cigna of CA PPO |
$705.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$810.05
|
| Rate for Payer: Global Benefits Group Commercial |
$571.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$635.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: Networks By Design Commercial |
$619.45
|
| Rate for Payer: Prime Health Services Commercial |
$810.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC PRE POST CHALLENGE SPIROMETRY
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
900801002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$190.60 |
| Max. Negotiated Rate |
$810.05 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.20
|
| Rate for Payer: EPIC Health Plan Senior |
$381.20
|
| Rate for Payer: Galaxy Health WC |
$810.05
|
| Rate for Payer: Global Benefits Group Commercial |
$571.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$635.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$589.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.72
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: Networks By Design Commercial |
$619.45
|
| Rate for Payer: Prime Health Services Commercial |
$810.05
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$456.45 |
| Rate for Payer: Adventist Health Commercial |
$107.40
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.80
|
| Rate for Payer: EPIC Health Plan Senior |
$214.80
|
| Rate for Payer: Galaxy Health WC |
$456.45
|
| Rate for Payer: Global Benefits Group Commercial |
$322.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$332.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.88
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: Networks By Design Commercial |
$349.05
|
| Rate for Payer: Prime Health Services Commercial |
$456.45
|
|
|
HC PREP SPLIT UNIT
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
900904439
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$107.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$329.77
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cash Price |
$241.65
|
| Rate for Payer: Cigna of CA HMO |
$343.68
|
| Rate for Payer: Cigna of CA PPO |
$397.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$456.45
|
| Rate for Payer: Global Benefits Group Commercial |
$322.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$358.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: Networks By Design Commercial |
$349.05
|
| Rate for Payer: Prime Health Services Commercial |
$456.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
905352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$905.25 |
| Rate for Payer: Adventist Health Commercial |
$436.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$585.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$798.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$616.85
|
| Rate for Payer: Blue Shield of California Commercial |
$785.97
|
| Rate for Payer: Blue Shield of California EPN |
$517.59
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$905.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$905.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$440.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$745.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$745.50
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.25
|
| Rate for Payer: Vantage Medical Group Senior |
$905.25
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
905352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.60
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
915352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.60
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
|
|
HC PRE-TIBIAL SHELL MOLDED ADDITON LE
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT L2340
|
| Hospital Charge Code |
915352340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$905.25 |
| Rate for Payer: Adventist Health Commercial |
$436.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$585.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$798.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$616.85
|
| Rate for Payer: Blue Shield of California Commercial |
$785.97
|
| Rate for Payer: Blue Shield of California EPN |
$517.59
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cigna of CA HMO |
$745.50
|
| Rate for Payer: Cigna of CA PPO |
$745.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$905.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$905.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$440.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$745.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$745.50
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$532.50
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$399.69
|
| Rate for Payer: United Healthcare All Other HMO |
$389.04
|
| Rate for Payer: United Healthcare HMO Rider |
$380.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$905.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.25
|
| Rate for Payer: Vantage Medical Group Senior |
$905.25
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
IP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$1,964.35 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
|
|
HC PREVIEW TRT PLANNING
|
Facility
|
OP
|
$2,311.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909201982
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$462.20 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$462.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,271.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,733.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,419.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.33
|
| Rate for Payer: Blue Shield of California EPN |
$933.64
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cash Price |
$1,039.95
|
| Rate for Payer: Cigna of CA HMO |
$1,479.04
|
| Rate for Payer: Cigna of CA PPO |
$1,710.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,964.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,964.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.40
|
| Rate for Payer: EPIC Health Plan Senior |
$924.40
|
| Rate for Payer: Galaxy Health WC |
$1,964.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,541.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,430.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,617.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,617.70
|
| Rate for Payer: Multiplan Commercial |
$1,848.80
|
| Rate for Payer: Networks By Design Commercial |
$1,502.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,964.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,386.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,386.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,155.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,155.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,155.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,155.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,964.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,964.35
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908603033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC PREVNAR ADMINISTRATION
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908603033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
900293260
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.78
|
| Rate for Payer: Blue Shield of California Commercial |
$68.54
|
| Rate for Payer: Blue Shield of California EPN |
$45.25
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.36
|
| 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 |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$118.15 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Senior |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.36
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$680.50 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: Cigna of CA HMO |
$6,429.15
|
| Rate for Payer: Cigna of CA PPO |
$7,319.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$680.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,934.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,934.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$680.50 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: Cigna of CA HMO |
$6,330.24
|
| Rate for Payer: Cigna of CA PPO |
$7,319.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$680.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,934.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,978.20 |
| Max. Negotiated Rate |
$8,407.35 |
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,956.40
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,768.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,122.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$9,891.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,978.20 |
| Max. Negotiated Rate |
$8,407.35 |
| Rate for Payer: Adventist Health Commercial |
$1,978.20
|
| Rate for Payer: Cash Price |
$4,450.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,956.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,956.40
|
| Rate for Payer: Galaxy Health WC |
$8,407.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,934.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,597.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,768.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,122.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,912.80
|
| Rate for Payer: Networks By Design Commercial |
$6,429.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,407.35
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$680.50 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$7,673.85
|
| Rate for Payer: Cash Price |
$7,673.85
|
| Rate for Payer: Cash Price |
$7,673.85
|
| Rate for Payer: Cigna of CA HMO |
$11,084.45
|
| Rate for Payer: Cigna of CA PPO |
$12,619.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$680.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$769.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,092.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$13,642.40
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,231.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,231.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$17,053.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906820231
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,410.60 |
| Max. Negotiated Rate |
$14,495.05 |
| Rate for Payer: Adventist Health Commercial |
$3,410.60
|
| Rate for Payer: Cash Price |
$7,673.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,821.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,821.20
|
| Rate for Payer: Galaxy Health WC |
$14,495.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,231.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,374.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,497.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,555.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,092.72
|
| Rate for Payer: Multiplan Commercial |
$13,642.40
|
| Rate for Payer: Networks By Design Commercial |
$11,084.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,495.05
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,876.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,740.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: Cigna of CA HMO |
$9,164.80
|
| Rate for Payer: Cigna of CA PPO |
$10,596.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,172.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,440.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,436.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,024.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,024.00
|
| Rate for Payer: Multiplan Commercial |
$11,456.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,592.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,172.00
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$14,320.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
906820198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,864.00 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,455.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,436.80
|
| Rate for Payer: Multiplan Commercial |
$11,456.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
|
