|
HC ASSESS APHASIA GROUP ICAP
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601908
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$83.84
|
| Rate for Payer: Cigna of CA PPO |
$96.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.06
|
| Rate for Payer: InnovAge PACE Commercial |
$65.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Riverside University Health System MISP |
$52.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$866.70 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$770.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$866.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.60
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$866.70 |
| Rate for Payer: Adventist Health Commercial |
$394.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$584.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$770.40
|
| Rate for Payer: Cigna of CA HMO |
$616.32
|
| Rate for Payer: Cigna of CA PPO |
$712.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$866.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.06
|
| Rate for Payer: InnovAge PACE Commercial |
$481.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.10
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
| Rate for Payer: Riverside University Health System MISP |
$385.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.55
|
| Rate for Payer: Vantage Medical Group Senior |
$818.55
|
|
|
HC ASSESS APHASIA W/RPT 60 MIN
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601803
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$866.70 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$770.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$866.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.60
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
|
|
HC ASSESS APHASIA W/RPT 60 MIN
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601803
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$866.70 |
| Rate for Payer: Adventist Health Commercial |
$394.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$584.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$722.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Central Health Plan Commercial |
$770.40
|
| Rate for Payer: Cigna of CA HMO |
$616.32
|
| Rate for Payer: Cigna of CA PPO |
$712.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$818.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$818.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$818.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$866.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.06
|
| Rate for Payer: InnovAge PACE Commercial |
$481.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.10
|
| Rate for Payer: Multiplan Commercial |
$722.25
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
| Rate for Payer: Riverside University Health System MISP |
$385.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$577.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$818.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$818.55
|
| Rate for Payer: Vantage Medical Group Senior |
$818.55
|
|
|
HC AST
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC AST INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC AST INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,294.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,124.91
|
| 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 |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: Cigna of CA HMO |
$17,571.84
|
| Rate for Payer: Cigna of CA PPO |
$20,317.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: InnovAge PACE Commercial |
$13,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
| Rate for Payer: Riverside University Health System MISP |
$10,982.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,728.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,728.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,728.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,491.20 |
| Max. Negotiated Rate |
$24,710.40 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,294.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,124.91
|
| 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 |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: Cigna of CA HMO |
$17,571.84
|
| Rate for Payer: Cigna of CA PPO |
$20,317.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: InnovAge PACE Commercial |
$13,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
| Rate for Payer: Riverside University Health System MISP |
$10,982.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,728.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,728.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,728.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,491.20 |
| Max. Negotiated Rate |
$24,710.40 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Central Health Plan Commercial |
$984.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.00
|
| Rate for Payer: EPIC Health Plan Senior |
$492.00
|
| Rate for Payer: Galaxy Health WC |
$1,045.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$820.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$761.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: Networks By Design Commercial |
$799.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,045.50
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$746.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$676.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$922.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$595.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$722.38
|
| Rate for Payer: Blue Shield of California Commercial |
$746.61
|
| Rate for Payer: Blue Shield of California EPN |
$488.31
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Central Health Plan Commercial |
$984.00
|
| Rate for Payer: Cigna of CA HMO |
$787.20
|
| Rate for Payer: Cigna of CA PPO |
$910.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,045.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.00
|
| Rate for Payer: EPIC Health Plan Senior |
$492.00
|
| Rate for Payer: Galaxy Health WC |
$1,045.50
|
| Rate for Payer: Global Benefits Group Commercial |
$738.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,107.00
|
| Rate for Payer: InnovAge PACE Commercial |
$615.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$820.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$761.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.00
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: Networks By Design Commercial |
$799.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,045.50
|
| Rate for Payer: Riverside University Health System MISP |
$492.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$615.00
|
| Rate for Payer: United Healthcare All Other HMO |
$615.00
|
| Rate for Payer: United Healthcare HMO Rider |
$615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$615.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,045.50
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,294.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,124.91
|
| 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 |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: Cigna of CA HMO |
$17,571.84
|
| Rate for Payer: Cigna of CA PPO |
$20,317.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: InnovAge PACE Commercial |
$13,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
| Rate for Payer: Riverside University Health System MISP |
$10,982.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,728.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,728.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,728.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,491.20 |
| Max. Negotiated Rate |
$24,710.40 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,212.20 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,966.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,212.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,521.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.60
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,212.20 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,492.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,843.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,190.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,443.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,492.01
|
| Rate for Payer: Blue Shield of California EPN |
$975.83
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,966.40
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,089.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,089.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,212.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,229.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,521.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,720.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,720.60
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Riverside University Health System MISP |
$983.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,229.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,089.30
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,491.20 |
| Max. Negotiated Rate |
$24,710.40 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,294.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,124.91
|
| 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 |
$15,100.80
|
| Rate for Payer: Cash Price |
$15,100.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,964.80
|
| Rate for Payer: Cigna of CA HMO |
$17,571.84
|
| Rate for Payer: Cigna of CA PPO |
$20,317.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,982.40
|
| Rate for Payer: Galaxy Health WC |
$23,337.60
|
| Rate for Payer: Global Benefits Group Commercial |
$16,473.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,710.40
|
| Rate for Payer: InnovAge PACE Commercial |
$13,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,313.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,460.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,995.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,491.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,219.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: Networks By Design Commercial |
$17,846.40
|
| Rate for Payer: Prime Health Services Commercial |
$23,337.60
|
| Rate for Payer: Riverside University Health System MISP |
$10,982.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,728.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,728.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,728.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,212.20 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,966.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,212.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,521.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.60
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,212.20 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,492.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,843.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,190.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,443.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,492.01
|
| Rate for Payer: Blue Shield of California EPN |
$975.83
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,966.40
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,089.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,089.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,212.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,229.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,521.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,720.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,720.60
|
| Rate for Payer: Multiplan Commercial |
$1,843.50
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Riverside University Health System MISP |
$983.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,229.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,089.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,089.30
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$28,367.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$5,673.40 |
| Max. Negotiated Rate |
$25,530.30 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Central Health Plan Commercial |
$22,693.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,346.80
|
| Rate for Payer: Galaxy Health WC |
$24,111.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,530.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,920.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,559.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.40
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| Rate for Payer: Networks By Design Commercial |
$18,438.55
|
| Rate for Payer: Prime Health Services Commercial |
$24,111.95
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$28,367.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$37,417.93 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,815.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,913.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Central Health Plan Commercial |
$22,693.60
|
| Rate for Payer: Cigna of CA HMO |
$18,154.88
|
| Rate for Payer: Cigna of CA PPO |
$20,991.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$24,111.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,530.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34,223.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,920.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,573.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| Rate for Payer: Networks By Design Commercial |
$18,438.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Prime Health Services Commercial |
$24,111.95
|
| Rate for Payer: Prime Health Services Medicare |
$24,184.76
|
| Rate for Payer: Riverside University Health System MISP |
$25,097.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,020.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,020.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
