|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$269.57 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| 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 |
$3,490.94
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO |
$9,310.72
|
| Rate for Payer: Cigna of CA PPO |
$10,765.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$269.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,491.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$11,638.40
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,728.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$14,969.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$269.57 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,232.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,226.75
|
| 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 |
$3,490.94
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: Cigna of CA HMO |
$9,580.16
|
| Rate for Payer: Cigna of CA PPO |
$11,077.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,723.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,723.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$269.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,265.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,478.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,478.30
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,981.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12,723.65
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$14,969.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$12,723.65 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,703.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,265.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,909.60 |
| Max. Negotiated Rate |
$12,365.80 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,542.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,491.52
|
| Rate for Payer: Multiplan Commercial |
$11,638.40
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
IP
|
$5,515.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,103.00 |
| Max. Negotiated Rate |
$4,687.75 |
| Rate for Payer: Adventist Health Commercial |
$1,103.00
|
| Rate for Payer: Cash Price |
$3,033.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,206.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,206.00
|
| Rate for Payer: Galaxy Health WC |
$4,687.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,678.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,101.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,413.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.60
|
| Rate for Payer: Multiplan Commercial |
$4,412.00
|
| Rate for Payer: Networks By Design Commercial |
$3,584.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,687.75
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
OP
|
$5,515.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,103.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,103.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,687.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,033.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,136.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,033.25
|
| Rate for Payer: Cash Price |
$3,033.25
|
| Rate for Payer: Cigna of CA HMO |
$3,529.60
|
| Rate for Payer: Cigna of CA PPO |
$4,081.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,687.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,687.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,687.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,206.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,206.00
|
| Rate for Payer: Galaxy Health WC |
$4,687.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,678.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,413.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,860.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,860.50
|
| Rate for Payer: Multiplan Commercial |
$4,412.00
|
| Rate for Payer: Networks By Design Commercial |
$3,584.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,687.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,309.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,687.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,687.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,687.75
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
OP
|
$6,184.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,236.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,236.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,256.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,401.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,638.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,401.20
|
| Rate for Payer: Cash Price |
$3,401.20
|
| Rate for Payer: Cigna of CA HMO |
$3,957.76
|
| Rate for Payer: Cigna of CA PPO |
$4,576.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,256.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,256.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,256.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,473.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,473.60
|
| Rate for Payer: Galaxy Health WC |
$5,256.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,124.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,827.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,484.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,328.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,328.80
|
| Rate for Payer: Multiplan Commercial |
$4,947.20
|
| Rate for Payer: Networks By Design Commercial |
$4,019.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,256.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,710.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,256.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,256.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,256.40
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
IP
|
$6,184.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,236.80 |
| Max. Negotiated Rate |
$5,256.40 |
| Rate for Payer: Adventist Health Commercial |
$1,236.80
|
| Rate for Payer: Cash Price |
$3,401.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,473.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,473.60
|
| Rate for Payer: Galaxy Health WC |
$5,256.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,356.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,827.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,484.16
|
| Rate for Payer: Multiplan Commercial |
$4,947.20
|
| Rate for Payer: Networks By Design Commercial |
$4,019.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,256.40
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
OP
|
$12,345.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,469.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,493.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,789.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,258.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,789.75
|
| Rate for Payer: Cash Price |
$6,789.75
|
| Rate for Payer: Cigna of CA HMO |
$7,900.80
|
| Rate for Payer: Cigna of CA PPO |
$9,135.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,493.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,493.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,493.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,938.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,938.00
|
| Rate for Payer: Galaxy Health WC |
$10,493.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,234.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,641.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,962.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,641.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,641.50
|
| Rate for Payer: Multiplan Commercial |
$9,876.00
|
| Rate for Payer: Networks By Design Commercial |
$8,024.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,493.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,407.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,493.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,493.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10,493.25
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
IP
|
$12,345.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,469.00 |
| Max. Negotiated Rate |
$10,493.25 |
| Rate for Payer: Adventist Health Commercial |
$2,469.00
|
| Rate for Payer: Cash Price |
$6,789.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,938.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,938.00
|
| Rate for Payer: Galaxy Health WC |
$10,493.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,234.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,703.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,641.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,962.80
|
| Rate for Payer: Multiplan Commercial |
$9,876.00
|
| Rate for Payer: Networks By Design Commercial |
$8,024.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,493.25
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$14,045.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,809.00 |
| Max. Negotiated Rate |
$11,938.25 |
| Rate for Payer: Adventist Health Commercial |
$2,809.00
|
| Rate for Payer: Cash Price |
$7,724.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,618.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,618.00
|
| Rate for Payer: Galaxy Health WC |
$11,938.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,427.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,368.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,351.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,693.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,370.80
|
| Rate for Payer: Multiplan Commercial |
$11,236.00
|
| Rate for Payer: Networks By Design Commercial |
$9,129.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,938.25
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$14,045.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,809.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$7,724.75
|
| Rate for Payer: Cash Price |
$7,724.75
|
| Rate for Payer: Cash Price |
$7,724.75
|
| Rate for Payer: Cigna of CA HMO |
$8,988.80
|
| Rate for Payer: Cigna of CA PPO |
$10,393.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$11,938.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,427.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$798.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,368.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,370.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$11,236.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$9,129.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,938.25
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,427.00
|
| 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 |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$13,650.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,730.00 |
| Max. Negotiated Rate |
$11,602.50 |
| Rate for Payer: Adventist Health Commercial |
$2,730.00
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,460.00
|
| Rate for Payer: Galaxy Health WC |
$11,602.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,190.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,104.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,200.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,449.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,276.00
|
| Rate for Payer: Multiplan Commercial |
$10,920.00
|
| Rate for Payer: Networks By Design Commercial |
$8,872.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,602.50
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$13,650.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.72 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,730.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: Cigna of CA HMO |
$8,736.00
|
| Rate for Payer: Cigna of CA PPO |
$10,101.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$11,602.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,190.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$798.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,104.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$903.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$10,920.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$8,872.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,602.50
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,190.00
|
| 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 |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,757.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$288.34 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,666.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,817.75
|
| 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 |
$3,490.94
|
| Rate for Payer: Cash Price |
$8,666.35
|
| Rate for Payer: Cash Price |
$8,666.35
|
| Rate for Payer: Cash Price |
$8,666.35
|
| Rate for Payer: Cigna of CA HMO |
$10,084.48
|
| Rate for Payer: Cigna of CA PPO |
$11,660.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,393.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,393.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,509.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,753.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,029.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,029.90
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,393.45
|
| Rate for Payer: Vantage Medical Group Senior |
$13,393.45
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,757.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$13,393.45 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Cash Price |
$8,666.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,302.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,302.80
|
| Rate for Payer: Galaxy Health WC |
$13,393.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,509.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,003.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,753.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.68
|
| Rate for Payer: Multiplan Commercial |
$12,605.60
|
| Rate for Payer: Networks By Design Commercial |
$10,242.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,393.45
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,062.80 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$288.34 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| 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 |
$3,490.94
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cigna of CA HMO |
$9,800.96
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,479.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,719.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,719.80
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: 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: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
915352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$1,444.80
|
| Rate for Payer: Cigna of CA PPO |
$1,444.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.36
|
| Rate for Payer: Multiplan Commercial |
$1,651.20
|
| Rate for Payer: Networks By Design Commercial |
$1,032.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.62
|
| Rate for Payer: United Healthcare All Other HMO |
$753.98
|
| Rate for Payer: United Healthcare HMO Rider |
$737.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.96
|
|
|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
915352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$495.36 |
| Max. Negotiated Rate |
$1,754.40 |
| Rate for Payer: Adventist Health Commercial |
$846.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,135.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,548.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,523.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,003.10
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$1,444.80
|
| Rate for Payer: Cigna of CA PPO |
$1,444.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,754.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,201.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,444.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,444.80
|
| Rate for Payer: Multiplan Commercial |
$1,651.20
|
| Rate for Payer: Networks By Design Commercial |
$1,032.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,238.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,238.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.62
|
| Rate for Payer: United Healthcare All Other HMO |
$753.98
|
| Rate for Payer: United Healthcare HMO Rider |
$737.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,754.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,754.40
|
|
|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
905352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$495.36 |
| Max. Negotiated Rate |
$1,754.40 |
| Rate for Payer: Adventist Health Commercial |
$846.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,135.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,548.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,195.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,523.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,003.10
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$1,444.80
|
| Rate for Payer: Cigna of CA PPO |
$1,444.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,754.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,754.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,201.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,444.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,444.80
|
| Rate for Payer: Multiplan Commercial |
$1,651.20
|
| Rate for Payer: Networks By Design Commercial |
$1,032.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,238.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,238.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.62
|
| Rate for Payer: United Healthcare All Other HMO |
$753.98
|
| Rate for Payer: United Healthcare HMO Rider |
$737.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,754.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,754.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,754.40
|
|
|
HC PTB SOCKET FOR AFO ADDITION LE
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
905352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$1,444.80
|
| Rate for Payer: Cigna of CA PPO |
$1,444.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.36
|
| Rate for Payer: Multiplan Commercial |
$1,651.20
|
| Rate for Payer: Networks By Design Commercial |
$1,032.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.62
|
| Rate for Payer: United Healthcare All Other HMO |
$753.98
|
| Rate for Payer: United Healthcare HMO Rider |
$737.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.96
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$14,969.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,232.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,226.75
|
| 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 |
$3,968.41
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: Cash Price |
$8,232.95
|
| Rate for Payer: Cigna of CA HMO |
$9,729.85
|
| Rate for Payer: Cigna of CA PPO |
$11,077.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,723.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,723.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,984.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,265.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,478.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,478.30
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,981.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,981.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12,723.65
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,909.60 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| 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 |
$3,968.41
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO |
$9,456.20
|
| Rate for Payer: Cigna of CA PPO |
$10,765.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,491.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$11,638.40
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,728.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,728.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,909.60 |
| Max. Negotiated Rate |
$12,365.80 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,819.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,819.20
|
| Rate for Payer: Galaxy Health WC |
$12,365.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,728.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,542.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,005.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,491.52
|
| Rate for Payer: Multiplan Commercial |
$11,638.40
|
| Rate for Payer: Networks By Design Commercial |
$9,456.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,365.80
|
|
