|
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 |
$6,891.30
|
| 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
|
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 |
$7,090.65
|
| 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 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 |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| 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 |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| 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 |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| 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 |
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 |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| 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 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 |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| 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
|
IP
|
$14,969.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| 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 |
$6,736.05
|
| 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 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 |
$6,546.60
|
| Rate for Payer: Cash Price |
$6,546.60
|
| 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 |
$6,546.60
|
| 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 PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.81
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO |
$135.00
|
| Rate for Payer: United Healthcare HMO Rider |
$135.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
OP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.60 |
| Max. Negotiated Rate |
$1,651.55 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,274.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,068.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,457.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,193.20
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cigna of CA HMO |
$1,243.52
|
| Rate for Payer: Cigna of CA PPO |
$1,437.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,651.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,651.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.20
|
| Rate for Payer: EPIC Health Plan Senior |
$777.20
|
| Rate for Payer: Galaxy Health WC |
$1,651.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,165.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,295.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,360.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,360.10
|
| Rate for Payer: Multiplan Commercial |
$1,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,262.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,651.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,165.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,165.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$971.50
|
| Rate for Payer: United Healthcare All Other HMO |
$971.50
|
| Rate for Payer: United Healthcare HMO Rider |
$971.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,651.55
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
IP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.60 |
| Max. Negotiated Rate |
$1,651.55 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.20
|
| Rate for Payer: EPIC Health Plan Senior |
$777.20
|
| Rate for Payer: Galaxy Health WC |
$1,651.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,165.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,295.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,202.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.32
|
| Rate for Payer: Multiplan Commercial |
$1,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,262.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,651.55
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$23,930.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,786.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$10,768.50
|
| Rate for Payer: Cash Price |
$10,768.50
|
| Rate for Payer: Cash Price |
$10,768.50
|
| Rate for Payer: Cigna of CA HMO |
$15,554.50
|
| Rate for Payer: Cigna of CA PPO |
$17,708.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$20,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,358.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$731.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,961.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,743.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$19,144.00
|
| Rate for Payer: Networks By Design Commercial |
$15,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$20,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,358.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,358.00
|
| 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 |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$23,930.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,786.00 |
| Max. Negotiated Rate |
$20,340.50 |
| Rate for Payer: Adventist Health Commercial |
$4,786.00
|
| Rate for Payer: Cash Price |
$10,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,572.00
|
| Rate for Payer: Galaxy Health WC |
$20,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,961.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,117.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,812.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,743.20
|
| Rate for Payer: Multiplan Commercial |
$19,144.00
|
| Rate for Payer: Networks By Design Commercial |
$15,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$20,340.50
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$24,622.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,924.40 |
| Max. Negotiated Rate |
$20,928.70 |
| Rate for Payer: Adventist Health Commercial |
$4,924.40
|
| Rate for Payer: Cash Price |
$11,079.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,848.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,848.80
|
| Rate for Payer: Galaxy Health WC |
$20,928.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14,773.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,422.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,380.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,241.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.28
|
| Rate for Payer: Multiplan Commercial |
$19,697.60
|
| Rate for Payer: Networks By Design Commercial |
$16,004.30
|
| Rate for Payer: Prime Health Services Commercial |
$20,928.70
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$24,622.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,924.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$11,079.90
|
| Rate for Payer: Cash Price |
$11,079.90
|
| Rate for Payer: Cash Price |
$11,079.90
|
| Rate for Payer: Cigna of CA HMO |
$16,004.30
|
| Rate for Payer: Cigna of CA PPO |
$18,220.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$20,928.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14,773.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$731.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,422.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$19,697.60
|
| Rate for Payer: Networks By Design Commercial |
$16,004.30
|
| Rate for Payer: Prime Health Services Commercial |
$20,928.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,773.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,773.20
|
| 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: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
IP
|
$1,118.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
OP
|
$1,118.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$458.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$733.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$782.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
908697163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$534.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$854.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$716.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$977.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cigna of CA HMO |
$833.92
|
| Rate for Payer: Cigna of CA PPO |
$964.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,107.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,107.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$912.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$912.10
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$781.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$781.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,107.55
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
900497163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$534.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$854.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$716.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$977.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cigna of CA HMO |
$833.92
|
| Rate for Payer: Cigna of CA PPO |
$964.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,107.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,107.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$912.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$912.10
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$781.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$781.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,107.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,107.55
|
|
|
HC PT INIT EVAL HIGH
|
Facility
|
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
908697163
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.20
|
| Rate for Payer: EPIC Health Plan Senior |
$521.20
|
| Rate for Payer: Galaxy Health WC |
$1,107.55
|
| Rate for Payer: Global Benefits Group Commercial |
$781.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$869.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$496.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$806.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.72
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Networks By Design Commercial |
$846.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,107.55
|
|
|
HC PT INIT EVAL LOW
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
900497161
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: Adventist Health Commercial |
$355.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$737.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$737.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$737.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$737.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$578.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$607.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$607.60
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$737.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$737.80
|
| Rate for Payer: Vantage Medical Group Senior |
$737.80
|
|
