|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.55
|
| Rate for Payer: Blue Shield of California EPN |
$680.40
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$616.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$747.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,043.55
|
| Rate for Payer: Blue Shield of California EPN |
$680.40
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$945.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: InnovAge PACE Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$945.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$675.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Riverside University Health System MISP |
$540.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.65
|
| Rate for Payer: United Healthcare All Other HMO |
$493.15
|
| Rate for Payer: United Healthcare HMO Rider |
$482.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$442.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,084.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$416.80 |
| Max. Negotiated Rate |
$1,875.60 |
| Rate for Payer: Adventist Health Commercial |
$416.80
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,667.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$833.60
|
| Rate for Payer: EPIC Health Plan Senior |
$833.60
|
| Rate for Payer: Galaxy Health WC |
$1,771.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,250.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,875.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.80
|
| Rate for Payer: Multiplan Commercial |
$1,563.00
|
| Rate for Payer: Networks By Design Commercial |
$1,354.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,771.40
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$61.97 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$974.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$857.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,040.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Cigna of CA HMO |
$1,151.15
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,505.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,505.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.97
|
| Rate for Payer: InnovAge PACE Commercial |
$885.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,239.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,239.70
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Riverside University Health System MISP |
$708.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,505.35
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,084.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$61.97 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$416.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,146.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,563.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,009.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,223.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,667.20
|
| Rate for Payer: Cigna of CA HMO |
$1,354.60
|
| Rate for Payer: Cigna of CA PPO |
$1,542.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,771.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,771.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$833.60
|
| Rate for Payer: EPIC Health Plan Senior |
$833.60
|
| Rate for Payer: Galaxy Health WC |
$1,771.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,250.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,875.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,042.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,390.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,458.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,458.80
|
| Rate for Payer: Multiplan Commercial |
$1,563.00
|
| Rate for Payer: Networks By Design Commercial |
$1,354.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,771.40
|
| Rate for Payer: Riverside University Health System MISP |
$833.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,250.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,250.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,771.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,771.40
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.69
|
| Rate for Payer: Blue Shield of California EPN |
$771.12
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$698.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$847.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,182.69
|
| Rate for Payer: Blue Shield of California EPN |
$771.12
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: InnovAge PACE Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,020.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$947.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Riverside University Health System MISP |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
OP
|
$10,402.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,080.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,080.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,841.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,721.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,801.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,036.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,109.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,721.10
|
| Rate for Payer: Cash Price |
$5,721.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,321.60
|
| Rate for Payer: Cigna of CA HMO |
$6,657.28
|
| Rate for Payer: Cigna of CA PPO |
$7,697.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,841.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,841.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,841.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,160.80
|
| Rate for Payer: Galaxy Health WC |
$8,841.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,361.80
|
| Rate for Payer: InnovAge PACE Commercial |
$5,201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,938.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,438.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,080.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,281.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,281.40
|
| Rate for Payer: Multiplan Commercial |
$7,801.50
|
| Rate for Payer: Networks By Design Commercial |
$6,761.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,841.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,160.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,241.20
|
| 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 |
$8,841.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,841.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,841.70
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
|
IP
|
$10,402.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,080.40 |
| Max. Negotiated Rate |
$9,361.80 |
| Rate for Payer: Adventist Health Commercial |
$2,080.40
|
| Rate for Payer: Cash Price |
$5,721.10
|
| Rate for Payer: Central Health Plan Commercial |
$8,321.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,160.80
|
| Rate for Payer: Galaxy Health WC |
$8,841.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,361.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,938.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,963.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,438.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,080.40
|
| Rate for Payer: Multiplan Commercial |
$7,801.50
|
| Rate for Payer: Networks By Design Commercial |
$6,761.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,841.70
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$315.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,342.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$868.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$764.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$927.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$868.45
|
| Rate for Payer: Cash Price |
$868.45
|
| Rate for Payer: Cash Price |
$868.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,263.20
|
| Rate for Payer: Cigna of CA HMO |
$1,026.35
|
| Rate for Payer: Cigna of CA PPO |
$1,168.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,342.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,342.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,342.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.60
|
| Rate for Payer: EPIC Health Plan Senior |
$631.60
|
| Rate for Payer: Galaxy Health WC |
$1,342.15
|
| Rate for Payer: Global Benefits Group Commercial |
$947.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,421.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.07
|
| Rate for Payer: InnovAge PACE Commercial |
$789.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$977.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,105.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,105.30
|
| Rate for Payer: Multiplan Commercial |
$1,184.25
|
| Rate for Payer: Networks By Design Commercial |
$1,026.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,342.15
|
| Rate for Payer: Riverside University Health System MISP |
$631.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$947.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$947.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,342.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,342.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,342.15
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
OP
|
$1,858.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906820072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$371.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,579.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,021.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,393.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$899.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,091.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,486.40
|
| Rate for Payer: Cigna of CA HMO |
$1,207.70
|
| Rate for Payer: Cigna of CA PPO |
$1,374.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,579.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,579.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,579.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.20
|
| Rate for Payer: EPIC Health Plan Senior |
$743.20
|
| Rate for Payer: Galaxy Health WC |
$1,579.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,672.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.07
|
| Rate for Payer: InnovAge PACE Commercial |
$929.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,150.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,300.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,300.60
|
| Rate for Payer: Multiplan Commercial |
$1,393.50
|
| Rate for Payer: Networks By Design Commercial |
$1,207.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,579.30
|
| Rate for Payer: Riverside University Health System MISP |
$743.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,114.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,114.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,579.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,579.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,579.30
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
IP
|
$1,858.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906820072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$371.60 |
| Max. Negotiated Rate |
$1,672.20 |
| Rate for Payer: Adventist Health Commercial |
$371.60
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,486.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.20
|
| Rate for Payer: EPIC Health Plan Senior |
$743.20
|
| Rate for Payer: Galaxy Health WC |
$1,579.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,672.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,150.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.60
|
| Rate for Payer: Multiplan Commercial |
$1,393.50
|
| Rate for Payer: Networks By Design Commercial |
$1,207.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,579.30
|
|
|
HC ANGIO RV/OR RA
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$315.80 |
| Max. Negotiated Rate |
$1,421.10 |
| Rate for Payer: Adventist Health Commercial |
$315.80
|
| Rate for Payer: Cash Price |
$868.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,263.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.60
|
| Rate for Payer: EPIC Health Plan Senior |
$631.60
|
| Rate for Payer: Galaxy Health WC |
$1,342.15
|
| Rate for Payer: Global Benefits Group Commercial |
$947.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,421.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,053.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$977.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.80
|
| Rate for Payer: Multiplan Commercial |
$1,184.25
|
| Rate for Payer: Networks By Design Commercial |
$1,026.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,342.15
|
|
|
HC ANGIOVAC ANGIODYN CANNULA SYS
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
906812646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
|
|
HC ANGIOVAC ANGIODYN CANNULA SYS
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
906812646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,182.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,682.50
|
| Rate for Payer: Blue Shield of California Commercial |
$15,275.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,975.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$20,000.00
|
| Rate for Payer: Cigna of CA HMO |
$16,000.00
|
| Rate for Payer: Cigna of CA PPO |
$18,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,000.00
|
| Rate for Payer: Galaxy Health WC |
$21,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,525.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,475.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Networks By Design Commercial |
$16,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC ANKLE ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
909000118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.35
|
| Rate for Payer: InnovAge PACE Commercial |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC ANKLE COMPLETE
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Adventist Health Commercial |
$224.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$682.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.40
|
| Rate for Payer: Blue Shield of California Commercial |
$681.66
|
| Rate for Payer: Blue Shield of California EPN |
$445.83
|
| Rate for Payer: Cash Price |
$617.65
|
| Rate for Payer: Cash Price |
$617.65
|
| Rate for Payer: Central Health Plan Commercial |
$898.40
|
| Rate for Payer: Cigna of CA HMO |
$718.72
|
| Rate for Payer: Cigna of CA PPO |
$831.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$954.55
|
| Rate for Payer: Global Benefits Group Commercial |
$673.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$749.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$842.25
|
| Rate for Payer: Networks By Design Commercial |
$729.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$954.55
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ANKLE COMPLETE
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
909001648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.60 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Adventist Health Commercial |
$224.60
|
| Rate for Payer: Cash Price |
$617.65
|
| Rate for Payer: Central Health Plan Commercial |
$898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.20
|
| Rate for Payer: EPIC Health Plan Senior |
$449.20
|
| Rate for Payer: Galaxy Health WC |
$954.55
|
| Rate for Payer: Global Benefits Group Commercial |
$673.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$749.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$695.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.60
|
| Rate for Payer: Multiplan Commercial |
$842.25
|
| Rate for Payer: Networks By Design Commercial |
$729.95
|
| Rate for Payer: Prime Health Services Commercial |
$954.55
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
OP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
915355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15,920.62 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Adventist Health Commercial |
$19,931.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,736.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,459.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,550.17
|
| Rate for Payer: Blue Shield of California Commercial |
$37,577.52
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$26,736.92
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,320.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,320.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: InnovAge PACE Commercial |
$24,306.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,424.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,091.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,931.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,028.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,028.81
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$24,306.29
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: Riverside University Health System MISP |
$19,445.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,167.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,167.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Senior |
$41,320.69
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
IP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
905355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,722.52 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Adventist Health Commercial |
$9,722.52
|
| Rate for Payer: Blue Shield of California Commercial |
$37,577.52
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$26,736.92
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,424.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,521.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,091.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,722.52
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$31,598.18
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
OP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
905355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15,920.62 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Adventist Health Commercial |
$19,931.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,736.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,459.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,550.17
|
| Rate for Payer: Blue Shield of California Commercial |
$37,577.52
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$26,736.92
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$41,320.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41,320.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: InnovAge PACE Commercial |
$24,306.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,424.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,091.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,931.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,028.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,028.81
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$24,306.29
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: Riverside University Health System MISP |
$19,445.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,167.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,167.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41,320.69
|
| Rate for Payer: Vantage Medical Group Senior |
$41,320.69
|
|
|
HC ANKLE-FOOT SYS DORS-PLANT FLEX
|
Facility
|
IP
|
$48,612.58
|
|
|
Service Code
|
CPT L5973
|
| Hospital Charge Code |
915355973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,722.52 |
| Max. Negotiated Rate |
$43,751.32 |
| Rate for Payer: Adventist Health Commercial |
$9,722.52
|
| Rate for Payer: Blue Shield of California Commercial |
$37,577.52
|
| Rate for Payer: Blue Shield of California EPN |
$24,500.74
|
| Rate for Payer: Cash Price |
$26,736.92
|
| Rate for Payer: Central Health Plan Commercial |
$38,890.06
|
| Rate for Payer: Cigna of CA HMO |
$34,028.81
|
| Rate for Payer: Cigna of CA PPO |
$34,028.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,445.03
|
| Rate for Payer: EPIC Health Plan Senior |
$19,445.03
|
| Rate for Payer: Galaxy Health WC |
$41,320.69
|
| Rate for Payer: Global Benefits Group Commercial |
$29,167.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,751.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,424.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,521.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,091.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,722.52
|
| Rate for Payer: Multiplan Commercial |
$36,459.43
|
| Rate for Payer: Networks By Design Commercial |
$31,598.18
|
| Rate for Payer: Prime Health Services Commercial |
$41,320.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,244.30
|
| Rate for Payer: United Healthcare All Other HMO |
$17,758.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17,374.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,920.62
|
|
|
HC ANKLE LIMITED
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
909001642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$582.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: Blue Shield of California Commercial |
$582.11
|
| Rate for Payer: Blue Shield of California EPN |
$380.72
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
