|
HC PTA ILIAC
|
Facility
|
IP
|
$15,757.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| 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 ILIAC EA ADDL
|
Facility
|
OP
|
$14,969.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cigna of CA HMO |
$9,580.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,433.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| 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 |
$7,484.50
|
| 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 |
$6,736.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| 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 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 |
$2,481.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,860.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,502.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,253.85
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,481.75
|
| Rate for Payer: Cash Price |
$2,481.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,860.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,502.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,253.85
|
| 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 |
$2,757.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,687.75
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$2,782.80
|
| Rate for Payer: Cash Price |
$2,782.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,328.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,926.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,648.56
|
| 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 |
$3,092.00
|
| 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 |
$2,782.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,328.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,926.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,648.56
|
| 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 |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$5,555.25
|
| Rate for Payer: Cash Price |
$5,555.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,641.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,839.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,283.55
|
| 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 |
$6,172.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 |
$5,555.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,641.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,839.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,283.55
|
| 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
|
OP
|
$14,045.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,809.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,809.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,938.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,724.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,533.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$6,320.25
|
| Rate for Payer: Cash Price |
$6,320.25
|
| Rate for Payer: Cash Price |
$6,320.25
|
| 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 |
$11,938.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,938.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,938.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,831.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,918.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,098.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,286.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,370.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,831.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,831.50
|
| 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 |
$7,022.50
|
| 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 |
$11,938.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,938.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,938.25
|
|
|
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 |
$6,320.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,831.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,918.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,286.55
|
| 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 EA ADDL
|
Facility
|
OP
|
$15,757.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Cash Price |
$7,090.65
|
| Rate for Payer: Cash Price |
$7,090.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,719.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| 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 |
$7,878.50
|
| 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 |
$7,090.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,029.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10,005.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,296.63
|
| 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
|
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 |
$1,249.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,587.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,046.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,201.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,310.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,359.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,217.76
|
| 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 |
915352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,310.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,217.76
|
| 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 |
$1,341.60
|
| 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
|
IP
|
$2,064.00
|
|
|
Service Code
|
CPT L2350
|
| Hospital Charge Code |
905352350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,310.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,217.76
|
| 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 |
$1,341.60
|
| 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 |
$1,249.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,587.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,046.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,201.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,310.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,359.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,217.76
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,433.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| 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 |
$7,484.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| 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 |
$173.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| 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 |
$10,476.69 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,476.69
|
| 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 |
$1,246.82
|
| Rate for Payer: Cash Price |
$874.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,360.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,233.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,146.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,360.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,233.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,146.37
|
| 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
|
$24,622.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,924.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| 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 |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,235.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| 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/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$731.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,634.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$826.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,909.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,223.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,809.20
|
| 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 |
$12,311.00
|
| 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 |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,235.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15,634.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,526.98
|
| 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
|
|
